Latest Cure for Panic Attack

Panic Away Ebook

Psychologists agree that when a person has anxiety of a certain situation, he may suffer from a panic attack. This person then fears that specific location or event. When he find himself in a similar situation, he fears the onset of an attack and essentially cause himself to have an anxiety attack in the process. The One Move method teaches you how to conquer these fears and end this vicious cycle. Panic Away provides a number of specific applications of the 21-7 Technique that relates to everyday life like how to deal with panic attacks while driving, leaving home, anxiety caused by the fear of flying and the fear of public speaking. That first key step to an anxiety free life, revealed in Panic Away, is shared and sinks in your brain in such a powerful way with the videos of Jane dealing with panic, that I give Panic Away my highest recommendation. Read more here...

Panic Away Summary


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Highly Recommended

The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

All the testing and user reviews show that Panic Away is definitely legit and highly recommended.

Diagnosis and Classification of Phobias and Other Anxiety Disorders Quite Different Categories or Just One Dimension

Phobias achieved a separate diagnostic status in psychiatric classifications soon after the Second World War, probably because of their frequent occurrence in soldiers at the battlefront. One of the main questions regarding their classification is related to a major issue among nosologists nowadays, at least for some classes of mental disorders such as anxiety disorders are they better represented by diagnostic categories or dimensions Evidence has been accumulated in the last 20 years showing that prototypical mental disorders such as major depressive disorders, anxiety disorders, schizophrenia and bipolar disorders seem to merge imperceptibly into one another and into normality 5 . However, it is somewhat unlikely that the next revision of psychiatric classification systems such as the DSM-V will turn from a categorical to a dimensional approach, since ''it is probably significant that most of the advocates of dimensional representation are not practicing clinicians but are...

Anxiety and Depression

As might be expected, within analogue samples the PSWQ correlates significantly with anxiety and depression as measured by the State Trait Anxiety Inventory (STAI Spielberger, 1983) and the Beck Depression Inventory (BDI Beck et al., 1961) respectively. Correlations with the STAI trait are found to be r 0.64-0.79 (Meyer et al., 1990 Davey, 1993 van Rijsoort et al., 1999 Wells & Carter, 1999). A lower correlation is reported with the STAI state, r 0.49 (Meyer et al., 1990), whereas correlations with the BDI are more variable, r 0.36-0.62 (Meyer et al., 1990 Van Rijsoort et al., 1999). Both worry (as measured by the PSWQ) and depressive rumination (as measured by the Response Styles Questionnaire, RSQ Nolen-Hoeksema & Morrow, 1991) are also highly correlated in a non-clinical population (r 0.51 Watkins, 2004). Within clinical populations, few studies have explored these relationships. In one small study (n 14) of individuals meeting the criteria for GAD (via GADQ), PSWQ scores...

Mixed anxiety and depression

Anxiety and depression often coexist, especially in the primary care setting. Patients with combined symptoms are the largest group with psychiatric conditions seen in the primary care office, and a substantial minority (45 ) are not detected by primary care physicians.57 Almost half of the cases of anxiety and depression occur in the same patient at the same time.60 This comorbidity makes accurate diagnosis more difficult, treatment more complicated, and prognosis less favorable.50 Anxiety is often the presenting symptom for depressed patients. The family physician should probe for symptoms for depression so that the depression can be identified and treated. Conversely, anxiety disorders often become comorbid with depression, and both conditions should be identified and managed. Fortunately, there is a great overlap in treatment methods, as the newer antidepressants are often indicated for the management of anxiety. 1 Olfson, M., Shea, S., Feder, A., et al. Prevalence of anxiety,...

State Trait Anxiety Inventory

Construction of the State-Trait Anxiety Inventory (STAI) began in 1964 with the goal of developing a single set of items to provide objective measures of state and trait anxiety. The concepts of state and trait anxiety were first introduced by Cattell.26 State anxiety and trait anxiety are analogous in certain respects to kinetic and potential energy. The anxiety state, like kinetic energy, refers to a palpable reaction or process taking place at a given time. On the other hand, anxiety traits, like potential energy, refer to individual differences in reactions.27 samples. One useful function of the STAI is for following patients during treatment. Since it only takes 6 to 7 min to administer this test, it can be used serially to evaluate levels of anxiety throughout the rehabilitation and treatment process.

The Epidemiology Of Worry And Generalized Anxiety Disorder

Once considered synonymous with the cognitive components of anxiety (Mathews, 1990 O'Neill, 1985), worry has emerged as a more specific construct that can not only be distinguished from a larger subset of cognitive aspects of anxiety, but also studied in its own right (Davey, 1993 Davey, Hampton, Farrell & Davidson, 1992 Zebb & Beck, 1998). One of the first attempts to define worry was provided by Borkovec, Robinson, Pruzinsky, and DePree (1983, p. 10) Research on the epidemiology of worry has largely evolved over the past 20 years. Much research appears to have been spurred by the adoption of worry as the essential feature of generalized anxiety disorder (GAD) in the revised, third edition of the Diagnostic and Statistical Manual of Mental

Measuring Mood Changes Beck Anxiety Inventory

The Beck Anxiety Inventory (BAI) is designed to measure subjective symptoms of anxiety in adolescents and adults. It is a self-administered inventory and contains 21 descriptive symptoms of anxiety that the patient rates on a 4-point scale 0 not at all 1 mildly, it did not bother me much 2 moderately, it was very unpleasant, but I could stand it and 3 severely, I could barely stand it. Scoring is performed by adding the raw scores for each of the 21 symptoms the maximum score the patient can achieve on this test is 63 points. Minimal anxiety ranges from scores of 0 to 7 points, mild anxiety ranges from scores of 8 to 15 points, moderate anxiety ranges from scores of 16 to 25 points, and greater than 26 points is consistent with severe anxiety.14 This inventory provides only an estimate of overall severity of anxiety. Since the test contains only 21 items, its discriminating power is thus weak as far as psychological tests go. Therefore, it is recommended that this test instrument be...

Generalized Anxiety Disorder

A number of investigations have focused on worry in the context of GAD, often using discriminant function analysis to distinguish older GAD patients from normal controls. In one such study, interference of worry in daily life, worry about minor matters, and worry about the future distinguished GAD from normal aging (Montorio et al., 2003). Similarly, frequency, excessiveness, number of topics of worry, perceived difficulty controlling worry, restlessness, fatigue, irritability, muscle tension, and sleep disturbance distinguished older GAD patients and normals (Wetherell, Le Roux et al., 2003). Older GAD patients reported higher levels of state and trait anxiety, worry, depression, and social fears than normal older adults (Beck et al., 1995). Subsyndromal GAD symptoms, or minor GAD, can be differentiated from both syndromal GAD and normal controls by scores on measures of pathological worry (PSWQ) and trait anxiety in the elderly (Diefenbach et al., 2003). Difficulty controlling worry...

The Epidemiology of Generalized Anxiety Disorder

Since their first iteration in DSM-III (APA, 1980) to their current version in DSM-IV (APA, 1994), the diagnostic criteria for GAD have been revised repeatedly, with revisions resulting in a greater focus on the presence of excessive and uncontrollable worry, an increase in the required duration of symptoms, fewer required physical symptoms, and the added requirement that worry and associated symptoms be accompanied by significant distress or impairment. In later editions, GAD was no longer considered a residual category that could only be diagnosed in the absence of other anxiety disorders. These significant changes to the structure of GAD have hampered long-term investigations of the course of the disorder and resulted in considerable heterogeneity in studies examining prevalence rates (Kessler, Walters & Wittchen, 2004 Wittchen, Zhao, Kessler & Eaton, 1994). Nevertheless, several epidemiological surveys provide valuable information regarding the prevalence, course, and associated...


Immediately after the diagnosis, a commonly experienced reaction is anxiety. Anxiety is a problem not only because it is intrinsically distressing, but also because it can interfere with good functioning. Anxious patients may be debilitated by their Anxiety is high when people are waiting for test results, receiving diagnoses or waiting for medical procedures and anticipating the adverse side-effects of treatment. Anxiety is also high when people expect substantial lifestyle changes to result from an illness or its treatment, when they feel dependent on health professionals, and when they lack information about the nature ofthe illness and its treatment. While anxiety that is directly attributable to the illness may decrease over time, anxiety about possible complications, the disease's implications for the future and its impact on work and social activities may actually increase.

Panic Disorder

ID CC A war veteran complains of intense and vivid flashbacks with associated anxiety and hyperarousal. Treatment Counseling should begin as soon after the traumatic event as possible. Some patients may benefit from benzodiazepines (for anxiety) and antidepressants. Discussion Seventy-five percent of patients drop out of counseling programs because remembering the traumatic event is too anxiety-provoking. PTSD may be classified as acute (duration of 3 months or less) or chronic (duration of more than 3 months).

Anxiety Symptoms

Although anxiety symptoms are essential for the diagnosis of anxiety disorders, they are so frequently encountered in depression that they should also be considered as an integral part of its clinical picture, particularly at the primary care settings. In ICD-10, the admixture of anxiety and depressive symptoms is listed as a distinct category under the term ''mixed anxiety and depressive disorders''.

Comorbidity and Associated Impairment

Early findings from the ECA study indicated a lifetime diagnosis of DSM-III GAD was associated with at least one additional Axis I disorder in 58 to 65 of respondents, with panic disorder and major depression the most frequent comorbid diagnoses (Blazer et al., 1991). As noted by Kessler and colleagues (2004), high rates of comorbidity for DSM-III GAD observed in early studies resulted in significant modifications to the disorder's diagnostic criteria, particularly the increase in required duration. one study meeting criteria for an additional Axis I disorder (Carter et al., 2001) and 60.6 of respondents in a separate study meeting criteria for an Axis II disorder (Grant et al., 2005). Though GAD appears to be a highly comorbid disorder in general population studies, Wittchen and colleagues (1994) showed that the frequency of individuals with GAD reporting one or more comorbid diagnoses is not much higher than rates observed in other anxiety or mood disorders. In clinical studies of...

Consequences Of Worry And Rumination Consequences of Worry

Worry has been linked to several negative consequences. Experimental inductions of worry have been shown to produce short-term increments in negative intrusive thoughts (e.g., York, Borkovec, Vasey & Stern, 1987). Furthermore, worrying briefly about a self-selected concern leads to increases in both anxiety and depression in non-clinical samples (Andrews & Borkovec, 1988). Wells and Papageorgiou (1995) examined the effects of worry on negative intrusive images following exposure to laboratory-induced stress (i.e., a brief film of an industrial accident). Following this film, participants were assigned randomly to one of five experimental conditions (1) worry about the film and its implications in verbal form, (2) image about the film and its implications, (3) engage in a distraction task consisting of letter cancellation, (4) worry about the things they usually worry about, and (5) settle down. At the end of the experimental manipulation, participants were asked to record the...

Gerald Matthews and Gregory J Funke Introduction

From concerns about job performance, to anxiety before a test, to apprehension before a presentation, people commonly worry about the outcomes of future events (Tallis, Davey & Capuzzo, 1994). Worry has been previously defined as an anticipatory cognitive process involving thoughts and images that contain fear-producing content related to possible traumatic events and their potentially catastrophic implications, which are rehearsed repeatedly without being resolved (e.g., Borkovec, Ray & Stober, 1978). Of key importance is that worry is primarily anticipatory in nature, relating mainly to future possibilities and the threats they pose. According to Eysenck (1992), worry has three major functions alarm, prompt, and preparation. Within his model, upon detection of an internal or external threat, the alarm function introduces information about the threat into conscious awareness. The prompt function then activates threat-related thoughts and images in long-term memory, and the...

Traits And State Constructs

Worry may be conceptualized as both a stable trait and as a transient mental state. By contrast with research on trait and state anxiety (e.g., Eysenck, 1992), worry research has focused primarily on trait assessments, such as the Penn State Worry Questionnaire (PSWQ Meyer et al., 1990). State worry has been investigated through thought sampling (Smallwood et al., 2004), measures of allied constructs, such as cognitive interference (Sarason et al., 1996), ad hoc indices, and multidimensional state assessment (Matthews, Campbell et al., 2002). We note briefly that there is considerable conceptual and empirical overlap between worry and rumination (e.g., Papageorgiou & Wells, 1999, Watkins, 2004 see Matthews & Wells, 2004, for a review of cognitive process models of rumination). Trait worry represents an outgrowth of the more broadly-defined construct of trait anxiety, which is seen as a facet of the personality superfactor of neuroticism (Matthews et al., 2003). Thus, at least in part,...

Encoding and Appraisal

The worry process begins with the detection of a potential threat. Threat detection may be triggered by external stimuli (being reminded of an upcoming worrisome event) or generated internally (remembering the date of the event). The early stages of processing threat stimuli are influenced by attentional processes, in that selection and prioritization of threat stimuli is likely to increase worry. It is well-established that general anxiety is associated with a selective attention bias towards detection of threat related information (MacLeod & Rutherford, 2004). The source of bias is often seen as pre-attentive and automatic, although Matthews & Wells (2000) review evidence suggesting a role for voluntary search for threat. Indeed, prioritization of threat processing may be supported by multiple component processes such as voluntary search for threat (Matthews & Harley, 1996), delayed disengagement from threat (Derryberry & Reed, 2002), and automatic threat encoding (Mathews &...

Associated Factors Genetics And Consequences

Worry in the elderly is associated with anxiety, distress, and negative affect (Skarborn & Nicki, 1996 Wisocki, 1994 Wisocki et al., 1986) poor self-perceived health, presence of medical conditions, or functional limitations (Hadjistavropoulos, Snider & Hadjistavropoulos, 2001 Skarborn & Nicki, 1996 Wisocki, 1988) approaching retirement (Skarborn & Nicki, 2000) and lower levels of knowledge about aging (Neikrug, 1998). In one recent study, older GAD patients reported impairment in quality of life comparable to that associated with major depression and more than that associated with Type II diabetes or recent acute myocardial infarct (Wetherell et al., 2004). A study of older adults reporting sleep difficulties indicated that they reported higher levels of worry than either self-reported good sleepers or normal controls (Pallesen et al., 2002), suggesting that insomnia may be one consequence of worry in later life. This is consistent with data from Wetherell, Le Roux et al. (2003)...

What Do Children And Adolescents Worry About

Reported more by older children compared to younger ones in a study of clinically referred anxious children (Weems, Silverman & La Greca, 2000). Similarly, Last, Strauss and Francis (1987) reported that children with a diagnosis of Overanxious Disorder Generalised Anxiety Disorder, were more likely to have a comorbid diagnosis of Social Phobia than any other anxiety disorder, indicating that in excessive worriers, worries about one's social functioning are paramount. Both academic and popular speculation surrounds the changing nature of worry in children as societies alter over time. Clearly it is difficult to study worry over historical time periods, but in one study that attempted this, the worries of North American children in the 5th and 6th grade in 1977, were compared to those reported by a similar cohort in 1939. It was found that boys in the 1930s worried more about economic issues, and girls in the 1970s worried more about all areas except for personal health. In general,...

Worry and Cognitive Attentional Biases

There is now substantial evidence in the adult literature to suggest that anxious adults have cognitive biases towards threat information, and overestimate the likelihood of such threat. Evidence is now beginning to suggest that these biases are apparent early on in the development of anxiety disorders i.e. in childhood and adolescence, (see Ehrenreick and Gross (2002) for a review).

Parents And Families Parentchild Relationships and Worry

It has now been demonstrated on a number of occasions, that childhood anxiety in general is associated with a pattern of parenting characterised by over-protection (see Wood, McLeod, Sigman et al. (2003) for a review). This finding has now been extended specifically to childhood worry, in a study by Muris (2002), which demonstrated that over-protective parenting (as reported by children) was associated with worry, in a large questionnaire study of 13-16 year olds. Similarly, we know that impaired parent-child attachment is associated with increased anxiety in the child (e.g. Warren, Huston, Egeland & Sroufe, 1997), and it has now been demonstrated that impaired attachment is Additional aspects of parenting that have been associated with anxiety in general, are 'rejection', 'emotional warmth', 'anxious parenting' and 'controlling' parenting, (which is similar to the concept of 'over-protection' described above). These constructs too, have now been associated specifically with worry....

NonGAD Symptomatic Samples

Nevertheless, high PSWQ scores are often present in non-GAD analogue clinical samples, including those with symptoms of post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD both in Molina & Borkovec, 1994), as well as panic disorder and social phobia (both from Erickson, 2002). Similarly, individuals diagnosed by questionnaire with analogue irritable bowel syndrome exhibit high levels of worry (Hazlett-Stevens, Craske, Mayer, Chang & Naliboff, 2003). Despite substantial worry elevation in these analogue non-GAD groups, analogue GAD groups manifest slightly higher average scores, as indicated in Table 7.2. However, because analogue studies have infrequently screened out other comorbid analogue conditions, such groups may well be symptomatically heterogeneous. In samples with clinically diagnosed patients, a parallel picture has emerged GAD patients tend to show higher PSWQ scores than other patients, though not in every case. For...

Worry and Ruminative Thought

Rumination is considered the cognitive component of depression and has been defined as behaviors and thoughts that focus one's attention on one's depressive symptoms and the implications and consequences of these symptoms (Nolen-Hoeksema & Morrow, 1993, pp. 561-562) (see Chapter 2). Within a non-clinical population, worry (as measured by the PSWQ), depressive rumination (as measured by the Response Style Questionnaire, RSQ Nolen-Hoeksema & Morrow, 1991), anxiety and depression (as measured by the Hospital Anxiety and Depression Scale, HADS Zigmond & Snaith, 1983) are all significantly positively correlated (smallest r 0.43) (Watkins, 2004).

Helen M Startup and Thane M Erickson

The need for a psychometrically sound measure of worry was reinforced by the introduction of DSM-III-R (American Psychiatric Association, 1987). With its introduction, Generalized Anxiety Disorder ceased being a residual diagnostic category. Although exclusion criteria still existed, the key variable of unrealistic or excessive anxiety and worry (apprehensive expectation) assumed paramount definitional significance for the disorder (APA, 1987, p. 252). The fundamental significance of this feature was further buttressed in the fourth edition of DSM (DSM-IV, APA, 1994), which added the requirement that worry be perceived as uncontrollable (Brown, Barlow & Liebowitz, 1994). With this in mind and by drawing together the available research of the time, Silvia Molina and Tom Borkovec (1994) noted that in order to adequately tap this phenomenon, it followed that a trait measure of worry would need to evaluate the following a) the typical tendency of the individual to worry, b) the...

The Sref Model Of Worry

Stable biases of these various kinds cause individual differences in dispositional worry, overlapping somewhat with general trait anxiety and neuroticism (Matthews et al., 2000). Importantly, traits relate to packages of biases that may be located in multiple, independent components of the architecture, given unity by their common functional orientation towards, in the case of dispositional worry, anticipation and preparation for threat (Matthews et al., 2003 Matthews & Zeidner, 2004). Traits such as neuroticism and dispositional metacognitive beliefs influence state worry in interaction with situational factors that may facilitate or inhibit the various process factors just listed. The role of worry processes in clinical anxiety pathology is largely beyond the scope of this chapter (see Matthews & Wells, 2000 Wells, 2000 for more detailed accounts), but we will indicate two differences between normal and pathological states of elevated worry. First, recent work using the DSSQ shows...

Etiology Of Worry States A Cognitive Perspective

There are multiple sources of cognitive bias that may elevate state worry in persons high in trait worry. Some biases are associated with neuroticism and trait anxiety, including negative self-beliefs, evidenced by their correlations with measures of self-concept, self-efficacy, self-esteem, and allied constructs (Matthews, et al., 2000,2003). Following Beck and Clark (1997), these biases have been conceptualized in terms of individual differences in the self-schema, the structured set of propositions held in LTM, although implicit, procedural self-knowledge may be equally important (Wells & Matthews, 1994).

PSWQ Scores in Relation to Demographic Variables

The PSWQ can also be used to assess worry in children (see Chapter 6), but may perform better in a revised format. Chorpita et al. (1997) adapted the PSWQ for youth by rewording nine items to second grade level and changing the Likert response scale from five to four points (0-3). Examination of psychometric properties in a community school sample of youth in grades 1-12 led to the elimination of two items. The remaining 14 items had a range of 0-42, yielding the PSWQ for Children (PSWQ-C). This measure demonstrated a single-factor structure, as well as satisfactory psychometric properties in student and clinical samples (see Table 7.3 for descriptives). In the unselected community sample, adolescents (age 12-18) scored higher than younger (age 6-11) children. In a separate sub-study, youths with GAD scored significantly higher than those with other anxiety disorders, who in turn scored significantly higher than non-anxious youths. Muris et al. (2001) examined PSWQ-C scores in a...

PSWQ Cut Points For Differentiating Various Groups

Recent studies have enhanced the utility of the PSWQ by testing for optimal cut-scores to screen for GAD caseness. Several studies have applied receiver operating characteristic analysis to determine PSWQ scores that optimize sensitivity (likelihood of identifying true positives from all persons with positive diagnosis according to the questionnaire) and specificity (likelihood of identifying true negatives from all persons without diagnosis on the measure) vis-a-vis clinician diagnosis or questionnaire-selected analogue GAD. Behar, Alcaine, Zuellig and Borkovec (2003) found that a PSWQ score of 45 optimized sensitivity and specificity in discriminating treatment-seeking GAD clients from non-anxious controls in contrast, in a large student sample, a score of 62 performed best. This latter, higher, score was required to differentiate analogue GAD individuals (categorized via GAD-Q-IV) from those with self-reported diagnoses of social anxiety disorder, moderate depression, and or PTSD....

Theories of Chronic and Pathological Worry

And Generalised Anxiety Disorder ____ 179 Chapter 12 A Cognitive Model of Generalized Anxiety Disorder The Role of and Generalised Anxiety Disorder ____ 259 and Generalized Anxiety Disorder ____ 273 Chapter 18 Pharmacological Treatments for Worry Focus on Generalised Anxiety Disorder 305 Anxiety Disorder 359

Why Do People Worry And Ruminate

Metacognitive Therapy Type Worry

In an earlier section of this chapter, the numerous negative consequences associated with worry and rumination were reviewed. Despite these consequences, it is puzzling to understand why people choose to engage in worry and rumination when stressors are encountered. Knowledge of the factors implicated in proneness to worry and rumination may contribute to our understanding of the mechanisms underlying the frequency and severity of worry and anxiety symptoms as well as rumination and depressive symptoms. Moreover, the modification of these factors may assist in reducing vulnerability to worry and rumination and maximising the efficacy of psychological interventions for anxiety and depression. A number of hypotheses have been advanced to account for the role of worry in anxiety and rumination in depression. Worry has been viewed as a form of avoidance (Borkovec & Inz, 1991 see Chapter 14), problem solving (Davey, 1994), coping strategy (Wells, 1994,1997), and intolerance of uncertainty...

The Content of Worry The Worry Domains Questionnaire Tallis Davey Bond 1992

The Worry Domains Questionnaire was developed as an instrument to measure non-pathological worry. By means of a cluster analytic method, six domains of worry were highlighted (1) Relationships, (2) Lack of Confidence, (3) Aimless Future, (4) Work Incompetence, (5) Financial and (6) Socio-Political (for a full description of scale development, see Tallis et al., 1994). The scale is comprised of 30 items. The prefix I worry is followed by a list of 30 worries (e.g., that I will lose close friends ) that cover the six worry domains, however, the sixth cluster (socio-political) may be dropped. For each item, participants indicate how much they worry on a five-point scale from not at all (0) to extremely (4). The WDQ can distinguish between high and low worriers drawn from a non-clinical population. The total WDQ score gives an indication of worry frequency, and the subscales provide information with respect to worry content. The resultant scale has shown internal consistency (Cronbach's...

Definitions and Characteristics of Rumination

Although there is little debate as to the concept of worry, it appears that different theorists define rumination somewhat differently despite the obvious similarities between the various definitions proposed. It has been noted that this problem is particularly reflected in the existing measures of rumination (Siegle, Moore & Thase, 2004). In a factor analytic study of different measures of rumination, Siegle et al. (2004) showed that there were several separate constructs represented in the measures. Thus, there appears to be a range of constructs of rumination, and it is conceivable that their contribution to dysphoria depression may differ. Moreover, psychometric tools assessing worry and rumination have been found to be highly correlated with each other, and with other measures of perseverative thinking, anxiety and depression (Fresco, Frankel, Mennin, Turk & Heimberg, 2002, Harrington & Blankenship 2002, Segerstrom, Tsao, Alden & Craske, 2000). Future research may assist in...

Julie Loebach Wetherell Prevalence

Furthermore, epidemiological research suggests that the prevalence of generalized anxiety disorder (GAD) is lower in those over 65 than in younger age groups (Blazer, George & Hughes, 1991). As is the case with most cross-sectional comparisons, it is impossible to determine the reason for these differences. It is possibly due to survival biases, in that people who have higher levels of worry are less likely to live to old age, or to cohort differences, given that people who are currently elderly survived World War II and the Great Depression and were typically raised with the values of self-reliance and minimizing or not discussing negative emotions. Older adults may not remember past episodes of worry. It is also possible that over the course of a lifetime, older adults develop wisdom (e.g. develop

Christine Purdon and Jennifer Harrington Worry In Psychopathology

Historically, worry has been viewed as simply a symptom, or side-effect of anxiety and not an especially interesting topic for study on its own. For example, O'Neill (1985) argued that worry will extinguish through the same mechanisms as anxiety (e.g., flooding), and so does not need to be identified or treated as a separate construct. Borkovec (1985) disagreed, arguing that worry is the cognitive component of anxiety and its relationship to the physiological and behavioral components of anxiety needs to be understood. Furthermore, early research suggested that worry may serve to actually elicit and maintain anxiety. Thus, worry might be a causal factor in anxiety, as opposed to solely being part of its phenomenology. This latter view now prevails (e.g., Barlow, 2002 Craske, 1999), and since those early debates, worry has been accepted as a topic of legitimate study. With respect to content, worry typically concerns negative future events and is an attempt to avoid negative outcomes...

Comparisons Between Worry And Rumination

The nature of worry and rumination suggests that these processes should overlap with and differ from each other. It is evident that worry and rumination can exist dynamically within the same individual. However, the study of similarities and differences between worry and rumination may offer a number of important opportunities. First, it may allow us to construct systematically a profile of the constituents of persistent negative thinking processes that contribute to specific and or general manifestations of psychological disturbance. In this way, an examination of the similarities and differences between worry and rumination may also assist in refining the proposed concepts. Whether the similarities or differences are key contributors to psychopathology is not yet clear. Second, this research may also facilitate the development and validation of idiosyncratic models for understanding perseverative negative thinking in anxiety and depression. Third, knowledge of similarities and...

The Phenomenology of Normal and Pathological Worry

Few empirical studies have actually examined the occurrence and phenomenology of worry independent of GAD (Tallis, Davey & Capuzzo, 1994). As a result, much of our empirical understanding regarding what actually occurs when people worry, what they most often worry about, and how frequently they worry has been derived from examinations of nonanxious control groups. As noted by Ruscio (2002), these studies may not provide an accurate representation of the frequency and manifestation of normal worry because participants in these groups have been selected based on low worry scores and an absence of anxiety. In much of the empirical literature, normal worry has been regarded as mild, transient, generally limited in scope, and experienced by the majority of individuals (Ruscio, 2002, p. 378). However, without adequate studies of worry in normal individuals (i.e., not simply low-anxiety individuals), it is difficult to determine how much the above perception is based on specific...

Worry And Task Performance

Wells and Matthews (1994) point out that anxiety may have both direct and indirect effects on information-processing, attention, and performance. Direct effects are those that reflect the person's motivated attempts to cope with perceived threats and pressures. The prime example is the bias in selective attention towards threat associated with general anxiety. Worry may generate a feedback process in which bias in selective attention elevates awareness of threat and worry, which in turn maintains the focus of attention on sources of threat (Matthews & Wells, 2000). However, Yovel and Mineka (2005) found that general anxiety predicted selective attention bias for subliminally presented emotional Stroop stimuli, but the PSWQ did not. Worry may tend to affect later processing stages such as stimulus interpretation, metacognition, and volitional appraisal and coping processes more strongly than these early encoding processes. A recent study (Reidy, 2004) also suggests that trait anxiety...

Summary And Conclusion

Understanding these factors may facilitate identification, differentiation and treatment of these phenomena in clinical practice. Worry and rumination are associated with a number of negative affective, behavioural and cognitive consequences, which highlights the need to advance our understanding of these core processes and develop effective interventions to target them in therapy. An important way of enhancing our knowledge of these processes is to study the similarities and differences between worry and rumination. Although there is little disagreement regarding the content differences between worry and rumination, there is no conclusive evidence concerning process and metacognitive differences. Moreover, whether the process and metacognitive similarities or differences are key contributors to psychopathology also remains to be addressed in the future. Finally, we have seen that several hypotheses have been proposed to account for the role of worry...

Gender and Lifespan Differences

Table 1.2 Twelve-month prevalence of generalized anxiety disorder by age Table 1.2 Twelve-month prevalence of generalized anxiety disorder by age Several studies have found GAD to be the most prevalent anxiety disorder among elderly individuals (e.g., Beekman et al., 1998 Flint, 1994). As shown in Table 1.2, the 12-month prevalence of GAD in people 65 years of age and older appears to fall between 0.8 and 1.6 . However, a recent epidemiological survey of 4,051 individuals between the ages of 65 and 86 yielded higher rates, with 3.2 of participants meeting criteria for current GAD (Schovers, Beekman, Deeg, Jonker & van Tilburg, 2003).

Should We Be Worried About Worry In Childhood

It is now widely recognised that generic child anxiety, when severe, is deleterious to functioning, and can have long-term negative outcomes. For example, anxious children often subsequently develop depression (Kovacs, Gatsonis, Paulauskas & Richards, 1989), and may be at increased risk of substance misuse. (Kushner, Sher & Beitman, 1990). Even less serious levels of anxiety have been shown to have an impact on children's academic and social functioning (Pine, 1997). However, to the author's knowledge, no research has yet examined the impact of worrying (as distinct from generic anxiety symptoms) on children's functioning. However, if, as seems likely, excessive worry has the same impact on young sufferers as it does on adults, and if it has the same impact that we now know high levels of generic anxiety to have on children, then this is an area that should be of serious concern.

Reliability Of The Pswqinternal Consistency And Stability

The 16-item PSWQ has routinely demonstrated high internal consistency in the case of both clinical and non-clinical criterion groups (Molina & Borkovec, 1994). Cronbach's alpha coefficients have been shown to range between 0.88 and 0.95 for clinical samples (GAD patients and mixed anxiety disorder samples, as diagnosed by the Anxiety Disorders Interview Schedule-Revised ADIS-R, Di Nardo & Barlow, 1988) and non-clinical college student and community derived samples (assessed by questionnaire Borkovec, 1994 Brown et al., 1992 Davey, 1993 Molina & Stober, 1998 van Rijsoort et al., 1999). The PSWQ also demonstrates good test-retest reliability amongst samples of college students (r 0.74-0.92 over intervals of 2 to 10 weeks Molina & Borkovec, 1994 Meyer et al., 1990 Stober, 1998), as well as substantial inter-rater reliability amongst college students (when comparisons are made with peer ratings, intraclass correlation coefficient 0.42 Stober, 1998) and between peer and self-ratings...

Age of Onset and Clinical Course

Onset of GAD to occur between the late teens and late 20s, with later onset occurring when GAD develops after another anxiety disorder (Barlow, Blanchard, Vermilyea, Vermilyea & DiNardo, 1986 Brawman-Mintzer et al., 1993 Hoehn-Saric, Hazlett & McLeod 1993 Massion, Warshaw & Keller, 1993 Woodman, Noyes, Black, Schlosser & Yagla, 1999 Yonkers, Massion, Warsaw & Keller, 1996).

Interventions For Childhood Worry

Unfortunately, there are (to this author's knowledge) no interventions that have been directed specifically at childhood worry. There are now a number of Cognitive Behaviour Therapy (CBT) based treatments that appear to have efficacy in treating childhood and adolescent anxiety in general (e.g. see Cartwright-Hatton, Roberts, Chitasabesan et al. (2004) for a review). However, these interventions have largely been targeted at the emotional (e.g. fear) and physiological aspects of anxiety. Very few treatment protocols have modules specifically for dealing with worry. Indeed, because of the developmental limitations on children's ability to use the more cognitive elements of CBT, most interventions focus heavily on behavioural elements, such as exposure and relaxation. If evidence from the adult literature is indicative, it seems unlikely that these elements will have a substantial impact on worry. Where cognitive elements are incorporated into treatment, these are usually limited to...

Normal And Clinical Worry

It is clear that children and adolescents do experience worry, but to what extent do they experience levels that would qualify them for a diagnosis of Generalised Anxiety Disorder (GAD) Epidemiological studies vary substantially in the degree to which they report prevalences of GAD (or its earlier counterpart overanxious disorder). In a large epidemiological study of British children (Ford, Goodman & Meltzer, 1999) GAD (using DSM-IV criteria) was found to be present in less than 1 of 5-10 olds. However, in a study employing slightly less conservative DSM-III-R criteria for 'overanxious disorder' Boyle, Offord, Racine, et al. (1993) reported overanxious disorder in over 11 of their US sample of 6-11 year olds. However, these rates must be interpreted in the context of the sample under investigation, and in light of the particular instruments, criteria and other methodology employed. Similarly, Perrin and Last (1997) examined worry in pre-adolescents, diagnosed with anxiety disorders,...

Maladaptive Worry And Rumination

Certainly likely to contribute to psychopathology. Moreover, in the Self-Regulatory Executive Function (S-REF) model of emotional disorders, Wells and Matthews (1994, 1996) suggest that there are at least three factors that contribute to worry and rumination becoming pathological. For purposes of assessment, it may be useful to view these factors as the 3-Ws (l) When worry or rumination is used (e.g., in response to negative mood, before, during and or after threatening situations), (2) What worry or rumination may be used for (e.g., predominant problem-solving and coping strategies), and (3) Whether worry or rumination is negatively appraised (e.g., 'I have no control over my worry rumination'). The contribution of these factors to pathological varieties of worry and rumination is clearly supported by empirical evidence (for reviews, see Papageorgiou & Wells, 2004 Wells, 2000). The following examples will serve to illustrate these factors in maladaptive worry and rumination. An...

Ethnic and Cross Cultural Differences

Though several studies have examined differences in the occurrence of anxiety among various ethnic groups within a specific country, few have reported specifically on differences in the prevalence of GAD (e.g., Jenkins et al., 1997). Overall, findings from three epidemiological surveys conducted in the US have revealed few differences in the prevalence of GAD among representative ethnic groups (Blazer et al., 1991 Wang et al., 2000 Wittchen et al., 1994). In an examination of ethnic differences in worry in a nonclinical population, Scott, Eng, and Heimberg (2002) compared Caucasian, African-American, and Asian Asian-American students on measures of pathological worry, worry domains, and generalized anxiety. No differences were observed among the three groups with respect to pathological worry or generalized anxiety however, African-American participants reported significantly less worry regarding relationship stability, self-confidence, future aims, and work incompetence than the...

Recent Evidence From Studies of the DSSQ

Laboratory, using the Dundee Stress State Questionnaire (DSSQ Matthews et al., 2002), is exploring how dispositional worry constructs generate state worry. Matthews, Hillyard and Campbell (1999), in a study of test anxiety in students, showed that, at the trait level, there were two distinct cognitive factors that correlated with dispositional evaluation-worry. One factor represented a general dimension of heightened metacognition, defined by perceived uncontrollability of thoughts, positive and negative beliefs about thoughts, and meta-worry. A second factor of adaptive coping was defined most strongly by higher use of task-focused coping and reduced use of avoidance. Interestingly, emotion-focused coping, in the sense of self-criticism and wishful thinking, loaded primarily on metacognition, but also negatively on adaptive coping. A regression analysis showed that both factors independently contributed to the prediction of dispositional worry. Data were also collected on state worry...

Costas Papageorgiou

Although the tendency to engage in recurrent negative thinking about past stressful events, current difficulties, and anticipated future problems is a common psychological feature of a range of disorders, worry and rumination are considered to be core cognitive processes in generalised anxiety disorder and major depressive disorder, respectively. This chapter begins by examining definitions and characteristics of worry and rumination. The second section discusses processes implicated in maladaptive worry and rumination. The affective, behavioural and cognitive consequences of worry and rumination are considered in the third section of this chapter. In the fourth section, both conceptual and empirical comparisons are made between worry and rumination. The final section considers factors that may predispose certain individuals to engage in worry and rumination.


GAD has typically included the elements of psychoeducation and recognition of anxiety symptoms, relaxation training, cognitive restructuring, and imaginal and in vivo exposure to worrisome thoughts and situations with prevention of overly cautious behaviors. Effect sizes (Cohen's d) immediately following treatment have typically been in the large range for those studies comparing CBT to wait list or usual care (Mohlman et al., 2003, .65 Stanley et al., 2003, .75 Stanley et al., 2003, 1.01 Wetherell, Gatz, & Craske, 2003, .85) and in the small to medium range for those studies comparing CBT to an alternative treatment or attention placebo (Gorenstein et al., 2005, .36 Stanley et al., 1996, .28 Wetherell, Gatz et al., 2003, .29). These results are generally less favorable than in comparable studies with younger adults. In a pooled analysis of CBT trials for late-life GAD, amount of at-home practice was the most consistent predictor of improvement, both immediately after treatment and at...


Research from our group supports relationships between beliefs about worry, and anxiety (Cartwright-Hatton, Mather, Illingworth et al., 2004 Mather & Cartwright-Hatton, 2004). A large sample of adolescents was given an adolescent version of the Meta-Cognitions Questionnaire. The results indicated that children as young as 13 years reported the range of beliefs about their worry as reported by adults, and implicated in the meta-cognitive model (i.e. both positive and negative beliefs about worry, including some 'superstitious' type beliefs, and beliefs about the controllability of worry). They also engaged in examining their worry in the same way as adults. Moreover, the extent to which they endorsed these beliefs and processes was correlated with their anxiety levels in the same way as in adults. The meta-cognitive model of worry (Wells, 1995) is outlined in full in Chapter 11, but briefly, it was shown that adolescents who endorsed beliefs about the dangerousness of worry, and also,...


An 8-item brief form of the WS was used with a group of Alzheimer's disease patients and normal controls (LaBarge, 1993). Psychometric properties of the scale (internal consistency and unidimensional factor structure) were adequate in both groups. Worry correlated with state and trait anxiety and depression, but only modestly with measures of anger or self-esteem, and not with measures of cognitive or personality changes reported by a collateral source. The Penn State Worry Questionnaire (PSWQ Meyer, Miller, Metzger & Borkovec, 1990 see Chapter 7) has also been validated in older GAD patients and normal controls. One comparison found adequate internal consistency and a two-factor structure comprised of the negatively and positively worded items (Beck, Stanley & Zebb, 1995). Higher levels of worry were associated with more worry domains, more self-reported obsessive-compulsive symptoms, greater depression, and higher levels of state and trait anxiety. An 8-item version of the PSWQ...


The Consequences of Worrying Scale (Davey, Tallis, & Capuzzo, 1996) assesses the perceived positive and negative consequences of worrying and can be used with non-clinical samples. The scale assesses three dimensions representing the negative consequences of worrying (1) worrying disrupts effective performance, (2) worrying exaggerates the problem, and (3) worrying causes emotional discomfort. There are two factors representing the positive consequences of worrying (1) worry motivates and (2) worry helps analytic thinking. From the limited data available, the scale demonstrates good psychometric properties (Davey et al. 1996). The sub-scales correlate with other measures of worry, such as the PSWQ and WDQ and with relevant measures of psychopathology such as trait anxiety (BAI) and depression (BDI) (Davey et al. 1996). Interestingly, one study found that participants who held both negative and positive beliefs about the consequences of worrying scored significantly higher on various...


Table 1.1 Prevalence of generalized anxiety disorder in the community Table 1.1 Prevalence of generalized anxiety disorder in the community The prevalence of GAD has also been assessed in primary care settings. Findings from large scale investigations in several countries indicate that GAD is one of the most frequently diagnosed mental disorders in primary care, with a current prevalence rate between 3.7 and 8 (Maier et al., 2000 Olfson et al., 1997 Ormel et al., 1994 Ustun & Sartorius, 1995) and a 12-month prevalence rate of 10.3 (Ansseau et al., 2004). Among high utilizers of medical care, 21.8 of those who reported significant emotional distress met criteria for a current diagnosis of GAD, whereas 40.3 met criteria for GAD at some point in their lives (Katon et al., 1990). As noted by Wittchen (2002), the higher prevalence of GAD in primary care settings compared to the general population differs from patterns observed in most other anxiety disorders, suggesting that individuals...

Worry Content

In a comparison of normal older adults, those with subsyndromal anxiety, and GAD patients, worries about family and personal health were the most common topics of concern in all groups, but GAD patients worried more about all topics than the other groups (Montorio et al., 2003). All older adults tended to worry more about present concerns rather than past or future concerns. Worry correlated with anxiety. Interference of worry with daily life and worry about minor matters were the best predictors of GAD in this sample.

General Samples

Panic disorder by questionnaire Panic disorder with agoraphobia Panic disorder non-anxious according to diagnostic screen self-report questionnaires such as the original Generalized Anxiety Disorder Questionnaire (GADQ Roemer, Borkovec, Posa & Borkovec, 1995) or a version revised to match DSM-IV criteria (GAD-Q-IV Newman et al., 2000), they show average PSWQ scores near or below the scale's midpoint (Erickson, 2002 Molina & Borkovec, 1994). Persons not meeting GAD criteria during structured diagnostic interviews (in this case, the Anxiety Disorders Interview Schedule-Revised, ADIS-R DiNardo & Barlow, 1988) yield low scores as well (Molina & Borkovec, 1994). Unselected groups, whether in predominantly student samples (Erickson, 2004 Molina & Borkovec, 1994 Sibrava, 2005) or community samples (Gillis, Haaga & Ford, 1995 van Rijsoort et al., 1999) tend to exhibit slightly higher average scores, presumably reflecting the natural inclusion of a subset of high worriers in any general...

About The Editors

Graham Davey is Professor of Psychology at the University of Sussex in Brighton, UK. He has been an active researcher in areas associated with anxiety and its disorders, especially pathological worrying, phobias, and perseverative psychopathologies generally. He has published his research in many high-impact international journals including Journal of Abnormal Psychology, Behavioral & Brain Sciences, Journal of Experimental Psychology, and Behaviour Research & Therapy. He has authored or edited a total of 11 books, including Davey, G.C.L. (1997) (Ed) Phobias A handbook of theory, research and treatment, Chichester Wiley, and Davey, G.C.L. & Tallis, F. (1994) (Eds) Worrying Perspectives on theory, assessment and treatment, Chichester Wiley. He was elected President of the British Psychological Society from 2002-2003. Adrian Wells is Professor of Clinical & Experimental Psychopathology at the University of Manchester, and Professor II in Clinical Psychology at the Norwegian University...


Normal worry appears to be a fairly common phenomenon, and recent research suggests that pathological worry independent of GAD may be more prevalent that previously thought. Though some similarities have emerged between normal worry and worry associated with GAD, most investigations have found that individuals with GAD worry more frequently, worry more about miscellaneous topics, and find their worry more difficult to control than their nonanxious counterparts. However, as noted by Ruscio (2002), most comparisons of normal and pathological worry to date have involved individuals with GAD and those not meeting criteria for an anxiety disorder. Thus, given that most individuals who report pathological worry do not actually meet criteria for GAD, observed differences between GAD and nonanxious control samples may not be representative of true differences between normal and pathological worry. Future research would greatly benefit from more focused examinations of what actually...

List Of Contributors

Adult Anxiety Clinic, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122-6085, USA Adult Anxiety Clinic, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122-6085, USA Thomas L. Rodebaugh Adult Anxiety Clinic, Department of Psychology,

Scale Development

For a comprehensive description of the initial development of the PSWQ, the reader is referred to Meyer et al. (1990) and Molina and Borkovec (1994). To summarize Molina and Borkovec (1994), the PSWQ was derived from the factor analysis of 161 items thought to be related to worry. These items were drawn from clinical and research experience with GAD patients and worriers, daily diaries from GAD patients, a prior cognitive-somatic anxiety inventory, and theoretical views on worry. The resulting questionnaire, which asked participants to rate each item on a 5-point scale ( not at all typical to very typical ), was administered to 337 college students and submitted to factor analysis with oblique rotation. Seven factors emerged. However, because the goal was to create a trait measure of the general tendency to worry without regard to content-specific topics, subsequent attention was focused on the first factor, which reflected the frequency and intensity of worry in general (accounting...

Theories Of Worry

Relatively few studies have attempted to apply theories about worry to older adults. Because older adults appear to experience lower levels of arousal due to physiological changes in the autonomic nervous system associated with aging, worry may form a more important component of anxiety in the elderly than in younger adults. One recent investigation tested Wells' cognitive model of pathological worry in a sample of older Spanish adults and found that metaworry (positive and negative beliefs about worry) was a significant predictor of severity of worry and interference of worry in daily life even after controlling for trait anxiety, worry content, and uncontrollability of worry (Nuevo, Montorio & Borkovec, 2004).

Treatment of Early Localized Prostate Cancer

The optimum management of patients with localized prostate cancer remains controversial. Three major treatment options are available radical prostatectomy, radical radiotherapy (external beam radiotherapy EBRT or brachy therapy), and active surveillance (also known as active monitoring and watchful waiting). Each treatment involves its own risk. Radical treatments can cause harmful side effects including incontinence, erectile dysfunction, and even death, whereas watchful waiting causes anxiety relating to the presence of cancer and carries a risk of disease progression. However, outcomes in terms of overall survival appear similar with each of the three modalities.

Quantification Process

Scientific fields and disciplines constantly evolve, usually starting at a qualitative stage (by being mostly descriptive, as the early anatomical or zoological knowledge), to enter later into more quantitative stages (like counting the number of lobes of an organ, weighing it and or searching for a known geometrical shape to approximate it). It is obvious that some disciplines are more quantifiable and quantified than others. The cardiovascular and respiratory systems, for example, are easier in this respect because their variables have precise mathematical definitions. Psycho-physiology, instead, does not have yet clear-cut variables to work with and, as a consequence, its quantification process is slower. Variables like anxiety, fear or anguish are rather elusive.

Psychomotor Disturbances

Psychomotor disturbances have the advantage of being readily observed and even objectively measured. They include, on the one hand, agitation (hyperactivity) and on the other, retardation (hypoactivity). Although agitation, usually accompanied by anxiety, irritability and restlessness, is a common symptom of depression, it lacks specificity. In contrast, retardation, manifested as slowing of bodily movements, mask-like facial expression, lengthening of reaction time to stimuli, increased speech paucity and, at its extreme, as an inability to move or to be mentally and emotionally activated (stupor), is considered a core symptom of depression. Their presence is currently being used as a diagnostic symptom of the melancholic type of depression in DSM-IV and the severe depression with somatic symptoms in ICD-10.

Primacy and Recency Effects Getting the Right Cognitive

For example, if a question begins by describing a patient as having a generalized anxiety disorder, all of the information that follows will tend to be seen in that context, even though the anxiety disorder diagnosis may not be directly pertinent to the correct answer for the question.

Specific Instruments for Measuring the Severity of Depression

The HAM-D (Hamilton Rating Scale for Depression) is the most widely used observer-reporting scale all over the world, particularly in clinical trials. It requires special observation skills. It is biologically oriented, and somatic symptoms weigh preferentially on the total score. Nonetheless, it rates highly for anxiety symptoms 81,133 .

Depression the Complexity of its Interface with Soft Bipolarity

Of all the classificatory schemas for affective disorders, the unipolarbipolar distinction is the one that has the broadest consensus among both researchers and clinicians. Stefanis and Stefanis wisely avoid the term ''unipolar.'' This caution is justified in as much as an increasing body of research data has indicated the existence of a prevalent group of soft bipolar disorders that occupy an intermediary position between the two poles. Bipolar II, which is the prototype of soft bipolarity, has affinity to classic manic depressive illness from a familial standpoint, but in some respects resembles unipolar patients, especially from the point of view of anxiety comorbidity. Unlike unipolars, these patients tend to cycle with antide-pressants, hence the need for mood stabilizers. Their treatment is often a nightmare, because treatments for anxiety disorders tend to destabilize the course of these patients, and mood stabilizers may not always bring about the necessary stabilization....

Insufficient Treatment Response

Taking all the published evidence into account, we recommend the following in the case of inadequate treatment response if patients have not shown at least partial response to an adequate dose of a traditional antipsychotic after 2 to 3 weeks, compliance and plasma levels should be checked. This may lead to additional supportive psychosocial measures or to an adaptation of dose. If these modifications do not yield relevant results within the next 2 to 3 weeks, switching to a second-generation drug or clozapine is indicated. This recommendation is based on solid evidence considering clozapine. On the other hand, it is clinically prudent to try one of the newer antipsychotics first, although the evidence that these have advantages over traditional neuroleptics in such instances is indirect at best, in order to avoid the necessity of white blood count monitoring obligatory with clozapine treatment. Patients who are switched to one of the novel agents should be evaluated for treatment...

Limited Options on Diagnosing Depression

The presence of somatic symptoms further complicates diagnosing depressive disorders in patients with medical illnesses such as cancer or those who are elderly 1,2 . It maybe difficult to discern whether the somatic symptoms are due to depression or to the underlying medical or physical disease 3 . Some methods have been used effectively to overcome this difficulty, such as revising the number of criteria to be fulfilled 4 , or substituting some of the somatic symptoms with non-somatic ones 2 . The Hospital Anxiety and Depression Scale (HADS) has proved to be an effective scale to detect depression and assess its severity in patients with medical or physical illnesses, since it contains mainly cognitive and affective symptoms of depression and anxiety 5 .

Whether Non Phobic Uncued As Well as Phobic Cued Symptoms are Present

The absence of non-phobic (uncued, unexpected, unpredictable) anxiety or depression is per se insufficient to classify a phobia, but its presence strengthens the chance that one is seeing agoraphobia or social phobia. Whereas specific phobics rarely have other mental health problems, many agoraphobics also have non-phobic panics and anxiety without any particular trigger, often during depressive episodes 4,5,16,21 . The more diffuse forms of social phobia too are liable to low mood. Calling such associated non-phobic symptoms comorbidities seems premature, as that would imply their being separate from the phobia. Until this issue has been better explored, we prefer to call them associations rather than comorbidities. The association of phobias with non-phobic anxiety and depression was noted yet again in recent multivariate analyses. A higher order ''internalizing'' factor comprising several phobic and other anxiety disorders and mood disorders emerged in analyses of a US national...

Preoperative Planning

The information should be clear and understandable, in order for the patient to give his or her informed consent to the procedure. In addition to the patient's right to information, good preoperative information reduces preoperative anxiety, thereby decreasing stimulation of the sympathetic nerve system. Preoperative anxiety, cigarette smoking and other stimulation of the sympathetic nervous system, in addition to the surgical trauma, lead to an increase in peri-operative coronary thrombosis and vasospasms.

Anesthesia for Endovascular Interventions

Cedure and to augment sedation at the onset of the intervention. Premedication with 25 to 50 mg of diphenhydramine and 5mg of diazepam given orally 1 hour prior to the procedure relieves many patients of the anxiety and anticipation of the intervention. Once the patient is on the catheterization table, sedation with 1 to 2mg of lorazepam in addition to 50 mg of fentanyl provides further sedation and excellent pain control. The skin at the puncture site is infiltrated with the chosen local anesthetic and the potential track of the puncture needle is also infiltrated. If during the arterial puncture the patient complains of pain, additional local anesthetic can be infiltrated in the area directly through the Seldinger needle prior to arterial puncture.

Psychiatric syndromes

We have seen in Chapter 1 that traumatic brain injury of the closed-head type preferentially causes lesions in the frontal and temporal brain structures. Within these structures lie the primary neural systems for regulation of affect and mood. Thus, it is not surprising that the more classical psychiatric syndromes might be seen following brain injury.218 Neuropsychiatry syndromes following traumatic brain injury described earlier were distinguished by complex brain-behavior relationships that affect cognition or that might result in neurobehavioral syndromes. On the other hand, the more pure forms of psychiatric disturbance also occur following brain injury and do not necessarily carry the accompanying cognitive impairment of the neuropsychiatric disorders. McAllister and Green and others have reminded us that many psychiatric disorders, including mood disorders, psychotic disorders, anxiety disorders, and obsessive-compulsive disorders, occur with significantly increased frequency...

Current Classifications Of Phobic Disorders And Their Similarities And Differences

ICD-10 lists, under the heading ''Neurotic, stress-related and somatoform disorders'', F40 Phobic anxiety disorders, the diagnoses F40.0 Agoraphobia, 40.1 Social phobias and 40.2 Specific (isolated) phobias, which closely resemble those that DSM-IV-TR lists under the heading ''Anxiety disorders'' (300.21, 300.22, 300.23 and 300.29). ICD-10 lists, under F40 Phobic anxiety disorders, two diagnoses (F40.8 Other phobic anxiety disorders and F40.9 Phobic anxiety disorder unspecified) that have no counterpart in DSM-IV-TR. ICD-10 lists a diagnosis F41.0 Panic disorder (episodic paroxysmal anxiety) under F41 Anxiety disorders rather than F40 Phobic anxiety disorders (and excludes from it F40.0 Panic disorder with agoraphobia). DSM-IV-TR lists its counterpart 300.01 Panic disorder without agoraphobia under ''Anxiety disorders''.

Pharmacotherapy of nicotine addiction

The acute effects of smoking (calmness, alertness, increased concentration) can be positively reinforcing, whereas nicotine withdrawal symptoms (depressed mood, insomnia, irritability, anxiety, poor concentration, weight gain) are negatively reinforcing.49 Pharmacotherapy is an integral part of the treatment of nicotine dependence but is most effective with concurrent behavioral therapy. Both nicotine-replacement therapies and bupropion (Zyban ) double long-term smoking cessation rates and have, therefore, been recommended as first-line therapy by the Agency for Healthcare Research and Quality. Nicotine-replacement therapies (Food and Drug Administration (FDA)-approved), include 2- or 4-mg nicotine polacrilex gum, the nicotine patch, nicotine nasal spray, and the nicotine inhaler.49

And Protection During CEA

Regional anaesthesia is advocated by some clinicians because of the possibility of continuous neurological assessment and less haemodynamic instability. Disadvantages may include restlessness, anxiety and discomfort. It is well recognized that general anaesthetics have the ability to protect the brain during ischaemic conditions, mainly by decreasing oxygen demand (cerebral metabolic rate). Hypotension and tachycardia are frequent during general anaesthesia and often the administration of ai-adrenergic agonists such as phenylephrine is required, which in turn can lead to myocardial ischaemia.

Posttraumatic Stress Disorder

Treatment MAO inhibitors and selective serotonin reuptake inhibitors (SSRls) may be helpful for generalized social phobia. Beta-blockers or benzodiazepines may alleviate anxiety on an as-needed basis in specific social phobias (e.g., test-taking or performance anxiety). Discussion Exposure to the feared situation almost invariably causes anxiety in patients with social phobia. The individual recognizes that the fear is an unreasonable one. Frequent comorbidity with substance abuse and depression.

How do you feel about having diabetes

Immediately after diagnosis, people are often in a state of shock. They find that their usual ways of coping with problems do not work, at least temporarily, and they may experience intense feelings of disorganisation, anxiety, fear and other emotions. Eventually this crisis phase passes and people begin to develop a sense of how the diabetes will alter their lives and can be integrated into them. At this point, more long-term difficulties that require ongoing attention may become apparent.

The Right To Privacy As The Basis For Refusal Of Treatment

Twenty-one-year-old Karen Ann Quinlan had become comatose as a result of a combination of alcohol and tranquilizers. She remained alive on a respirator, but was judged by physicians to be irreversibly comatose, with no reasonable possibility of emerging from her comatose condition. Her parents attempted to have the respirator that artificially sustained her breathing to be withdrawn. In re Quinlan (N.J. 1976), the right to privacy was recognized as the basis for honoring her parents' right to refuse treatment on her behalf. (Although the respirator was removed, Quinlan died 8 years later.)

Obsessivecompulsive disorder

At least four million Americans suffer from obsessive-compulsive disorder (OCD).50 The condition is equally common in men and women and has a lifetime prevalence of 2-3 , although many cases are undiagnosed. Most cases begin before age 25, but OCD is a chronic, relapsing condition that may persist and be intractable in the middle-aged woman. Such women may present when they can no longer conceal the condition or a relapse is triggered by a life event. The condition may also present as a physical condition such as an intractable dermatitis of the hands due to repeated washing. Patients with OCD experience time-consuming, distressing obsessions and compulsions that impair normal functioning. Compulsions are repetitive, ritualized behaviors performed to prevent or relieve anxiety. Examples of compulsions include repeated hand-washing, cleaning, checking, counting, and hoarding. Typically, women with OCD have both obsessions and compulsions and usually hide the symptoms from family and...

Adapting to changes in appearance a psoriasis patients account

This patient's account conveys the feelings of anxiety, uncertainty, and helplessness that often accompany the diagnosis of a skin condition. Without the knowledge of when or how the condition will develop, the patient may be left wondering about what behaviours or actions might be contributing to its progression. Lifestyle or diet may be affected or, in some cases, particular rituals are adopted in order to gain some control over the course of their condition. Some patients who suffer from acne, for example, expose their skin to the sun for excessive amounts of time since they believe that the sun will 'dry up' their pimples.

Check Your Answers on Next Page

Verbal control should be the first attempt made. As you approach the patient, talk calmly to him. Avoid threatening him. Tell him who you are, where and how you plan to help him this is called reorienting information. Ask him questions about what is troubling him. Try to find the cause of his agitation. Asking why he is upset often stimulates the patient to think rationally. Additionally, these questions provide necessary information. Often, the verbal approach is enough to calm someone who is not in a panic, anxiety state. The verbal approach is usually effective with patients who are psychotic (person who has lost contact with reality).

Obtaining the History of Affective and Mood Changes

It is well recognized that it is difficult to diagnose a mood disorder in a prepubertal child, particularly if the child is below 7 years of age. Verbal communication is paramount in diagnosing a mood disorder in either adults or children, and most children under age 7 lack sufficient communication skills to describe their moods adequately. However, preschoolers with depression may look sad and have a reduced verbal communication following a brain injury. The parent or guardian should be asked about this in detail. Moreover, the child may move or talk more slowly. The normal communication of happiness through facial expression may alter following a brain injury. Common symptoms of depression in preschoolers also include loss of weight, a left shift on the growth curve, increased irritability and tearfulness, and somatic symptoms, particularly gastrointestinal discom-fort.95 With the older child, the examiner may be able to take the history directly from the youngster. Children between...

Interfacial Hydrophobicity and Potential Cholesterol and Raft Binding Motifs of the M2 PostTM Region

Vincent et al. (2002) pointed out that the cholesterol-binding pre-TM region of gp41 encompasses a cholesterol recognition interaction amino acid consensus-L V-X(15)-Y-X(15)-R K- (the CRAC motif) first identified in the peripheral-type benzodiazepine receptor, a protein involved in mitochondrial cholesterol transport (Li and Papadopoulos, 1998 Li et al., 2001). The M2 post-TM sequence exhibits one or two CRAC motifs immediately downstream of the TM domain (Figure 9.3). Of interest, the endodomain of the influenza B M2 protein (Mould et al., 2003 Paterson et al., 2003) also includes CRAC domains, albeit further downstream of the predicted TM segment. In HIV gp41 the motif is located adjacent but upstream of the TM domain, facing the extracellular space and the HIV exterior (Vincent et al., 2002). In most sequenced influenza A M2 proteins, a CRAC motif encompasses the palmitoylation site Cys50, and in many it is followed by a second CRAC motif. In a majority of human influenza A strains...

Integrating Psychotherapies in Clinical Practice

Secondly, we have developed our own general concept of psychotherapy, after some 40 years of clinical practice. It is the use of different psychological techniques, by a professional, to heal or help in the process of healing, relieving or soothing emotional pain, anxiety and or depression, to reduce, alleviate and solve symptoms and problems and, if possible, to restore functioning, thus facilitating the growth and development of patients or persons in need of help, or at least to be able to console or comfort them in their suffering.

Metformin and Repaglinide

A4 enzyme system, drugs that are metabolized through this system (Rifampin, barbiturates, carbamazepine, certain statin drugs, amiodarone, benzodiazepines, sildenafil (Viagra), theophylline, and certain selective serotonin reuptake inhibitors) may increase repaglinide metabolism (19). Although in vitro data indicate that repaglinide metabolism may be inhibited by antifungal agents (such as ketoconazole and miconazole) or antibacterial agents (such as clarithromycin), systematically acquired data is not available on increased or decreased plasma levels with other cytochrome P-450 3-A4 inhibitors or inducers.

Comorbidity in Social Phobia Nosological Implications

The introduction of operational diagnostic criteria for psychiatric disorders has stimulated interest in comorbidity, which is generally defined as the cooccurrence of two or more disorders over a specified period of time. The study of comorbidity has important implications for both clinical research and practice. It may contribute to the delineation of different disorders and, therefore, validate proposed diagnostic categories. Moreover, given that comorbidity of psychiatric disorders is a very frequent occurrence, confounding symptoms may frequently intrude and blur a prototypal clinical picture. Consequently, reference to comorbidity issues is deemed necessary for an adequate description and improved understanding of the phenomenology of a specific disorder. This applies in particular to anxiety disorders, with as many as 50 of patients having a specific anxiety disorder which may meet diagnostic criteria for another anxiety disorder 1 . Based on clinical studies as well as on...

Feb2002 Image 68 5er

Single-photon emission computed tomography (SPECT) produces both quantitative and qualitative measures of cerebral blood flow. The most common radioligand used to produce brain imaging of traumatic injury is 99mTc hexamethylpropylene amine oxime (HMPAO). It is injected intravenously and accumulated by endothelial cell membranes within several minutes. It concentrates in these cells proportional to regional cerebral blood flow, and its activity may remain constant for up to 24 h. Because of this, SPECT is useful in that it can be injected during very controlled conditions, away from the noise and anxiety of the scanning room. A snapshot of the relative cerebral perfusion can then be collected at a time later, up to several hours later. A second radioligand sometimes used for SPECT is 99mTc ethyl cysteinate dimer (ECD). This radioligand produces less extracerebral uptake, and it has some dramatically different patterns of uptake within the brain tissue compared with HMPAO. Thus, there...

Children and skin disease

This case illustrates some of the difficulties that can arise when a young child develops a skin condition. A central concern of this mother was her relationship and attachment to her child. Her story illustrates how anxiety-provoking it can be not to be able to bond easily with her child.

Giving Credit to Neglected or Minor Disorders

In the past, the phobias were either ''neglected'' or considered as ''minor'' disorders. The results of recent research in the field have highlighted the prevalence of phobias and the severity of the distress that is frequently associated with these disorders, as well as the impact on quality of life, interference with the person's normal routine, occupational functioning, social activities and relationships. This has led to a new and more adequate appreciation of the phobias in general and of social phobia in particular. In a recent study 1 we compared patients with social phobia to normal controls on measures of avoidance, using the Liebowitz Social Anxiety Scale 2 , assertiveness, using the Schedule for Assessing Assertive Behavior developed by Rathus 3 , quality of life, using the Quality of Life Rating Scale or WHO-QoL 4 , and disability, using the Disability Assessment Schedule, version II or WHO-DAS-II 5 . As was to be expected Marks and Mataix-Cols emphasize the fact that...

What about children with diabetes

It is very common for parents and families to have trouble coping with a child's illness and therefore good rapport and communication with the health-care professionals involved in your child's diabetes care is essential. Support groups and educational materials targeted towards families of very young children can help parents and families to feel less alone and can normalise feelings of guilt, anxiety and fear. It is important to accept the fact that diabetes won't just 'go away', but remember that diabetes management must not take over your family's life. Love, guide and discipline your child as if diabetes were not a factor and tell yourself that a diagnosis of diabetes does not have to be totally negative people grow and change not only when things are going well, but also when they are not

Depressive Disorders in Childhood and Adolescence State of the

As Harrington suggests, an important thrust for the future likely will be efforts to modify existing treatments to make them more sensitive to the fact that close to 50 of depressed young people have another mental disorder, the most common being conduct, substance use, anxiety, and attention deficit disorders 16 .

Initial Stabilization

The data, and making a decision about appropriate treatment interventions. For optimal benefit, initial therapy for acute MI should be in progress within 30 minutes of arrival at the emergency department. Most patients who die do so because they delay calling The average delay in seeking medical attention for acute MI is still between two and six hours.29 Once the patient is in the emergency department, IV access is established, supplemental oxygen provided, and pain and anxiety are addressed.

C Considerations and Precautions Associated with Venipuncture

(1) Behavioral problems may be encountered from some patients because of anxiety. Remember that the patient is not as familiar with the procedure as you are. The patient's apprehensions can be eased with a step-by-step explanation of what is going on. Always talk in a calm and assuring tone of voice. Do not forget to be tactful. Remember, treat the patient as you would want to be treated if you were at the other end of the needle.

Dementia as a Diagnostic Entity

Although some dementia cases will show improvement after treatment or supportive effort, in fact, it is assumed to be only a partial improvement caused by reorganization of the remaining functioning part of the brain. The process may, but not necessarily, be progressive and deteriorating as mentioned in Prof. Reisberg's review, the term 'progressive and deteriorating' may be unsuitable in some cases. However, the temporary nature and possibility of complete recovery of the cognitive deficits should negate the diagnostic consideration of dementia (e.g. temporary cognitive deficits found in conditions such as drug intoxication, depression, anxiety, schizophrenia, etc.).

How the Study of Early Onset Depression Challenges Us to Produce a New Paradigm for Understanding Mood Disorders

This diagnostic extension of the concept of depression is further complicated by the confusion of comorbidity, as recent debates on the diagnosis of bipolar disorder in young people have demonstrated. It is a leap of something akin to faith to believe that 60, 70 or 80 of depressed youngsters have an additional and unique psychiatric disorder Perhaps in our syndromatically based diagnostic developments we have debased the mathematical foundations of set theory and have happily developed what we feel are unique categories using shared elements. For example, a set of golf clubs cannot be confused with a set of hockey sticks, because the elements, although superficially similar, are essentially different, yet concentration and sleep problems (for example) can be used to define both depression and anxiety. Additionally, in many cases, we have assumed, and not confirmed, that diagnostic elements are part of the implied pathoetiology of a disorder (e.g. early morning awakening in...

How Dreams Are Products Of Our Minds

While the idea that the psychological state and the personality of a person contribute to dream generation can be found in ancient through contemporary writings, there is only a small correlation between what personality tests reveal about persons and the nature of their dreams. Anxious persons report more anxious dreams, and relaxation training that reduces anxiety in these persons results in an increase in the reported pleasantness in their dreams. Also, people successfully treated for their phobias report experiencing a reduction in phobic objects in their dreams. The dreams of depressed people contain more masochism, dependency, helplessness, and hopelessness, which is like their waking thoughts (Weiss, 1986). Furthermore, age and gender have been shown to cause great individual differences in recalled dream content, but social class, structure of the family, and health also can have an influence.

People With Panic And Phobias Sociodemographic Characteristics

What type of people suffer from panic and phobias Sociodemographic data restricted to panic and phobias are uncommon, but data on the demographic correlates of anxiety disorders do exist. People with panic and phobias comprise 80 of the people with anxiety disorders in most surveys, so data for anxiety disorders will be presented as a proxy for people with panic and phobias. The NCS found significantly increased odds ratios (an odds ratio of 2 means that the characteristic is twice as common in the nominated group) between a DSM-III-R diagnosis of an anxiety disorder and female gender, youth, poor education and low income but not with race or urbanicity 11 . The Australian survey 21 found significant adjusted odds ratios between ICD-10 diagnosis of an anxiety disorder and female gender, youth, separated divorced widowed, poor education and employment status, but not with race or urbanicity. Thus the results of the NCS and the Australian survey concur anxiety disorders, like affective...

Schizotypal Traits and Symptoms as Precursors of Schizophrenia

Only a minority of these studies used PD assessment tools, but most of them reported behavioural abnormalities preceding schizophrenia which might reflect premorbid personality traits. Particularly recent follow-back studies characterized later schizophrenics by depressive, negative and cognitive traits 66 . Follow-back studies also report higher rates of suspiciousness and unusual speech 67 . High-risk studies report poor affective control, social solitariness, irritability, maladaptive behaviour and cognitive disturbances to precede schizophrenia 68, 69 . Attentional deficits are the most common preceding characteristics of schizophrenia and schizotypal PD in the New York High-Risk Study 70 , with anhedonia operating as a potentiating factor. These reports are backed up by prospective birth cohort studies linking large-scale assessments in children with case registers later in life Crow et al 71 reported anxiety, depression, aversive behaviour, social withdrawal, cognitive...

Hypoxemia And Oxygen Therapy

Hypoxemia is treated by administering extra oxygen (oxygen therapy). Prolonged oxygen therapy and or high doses may cause respiratory complications such as hyperventilation or atelectasis. This is not a major concern in the pre-hospital environment and oxygen should never be withheld from anyone, especially in times of respiratory distress. Oxygen is normally supplied from tanks (also called cylinders and bottles) or from wall outlets (piped-in oxygen).

IRecent Use of Alcohol 24 Hours Drugs

(2) Some drugs may compromise cardiac output, respiration, sweating, or increase the basal metabolism rate thus producing more heat. Other drugs inhibit sweating (atropine) scopolamine, antihistamines, some tranquilizers, cold medicines, and some antidiarrheal medications.

Disability Attributed to Panic and Phobias

Comorbidity, especially concurrent comorbidity, makes it difficult to attribute current disability and service utilization. Mendlowicz and Stein 30 reviewed the use of quality of life instruments in people with anxiety disorders and noted that they markedly compromise quality of life and psychosocial functioning. Importantly, they noted that treatment can reduce this disability. Goering et al. 31 , reporting from the Ontario survey, noted that people with single affective disorders typically have more disability than people with single anxiety or substance use disorders and that people with multiple disorders have disability rates comparable with those with affective disorders. Stein and Kean 32 from the same survey reported that people with social phobia were impaired on a broad spectrum of measures, including low functioning on a ''quality of well-being scale''. Bijl and Ravelli 33 obtained a similar result from the Netherlands survey. Eating disorders and schizophrenia were...

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