•    “Pathological counterpart of normal fear, manifested by disturbances of mood, as  well as thinking, behavior, and physiological activity”
  • Anxiety is more than chronic stress and increased arousal  o Perception and concern over the threat  stressor  are disproportionate to the  actual threat

o Anxiety is usually experienced far longer than the arousal lasts  o Anxiety can occur in the absence of an actual threat

 

Anxiety Disorders

  •    Panic Disorder
  •    Phobias
  •    Generalized Anxiety Disorder
  •    Obsessive-Compulsive Disorder
  •     Post-Traumatic Stress Disorder

 

 

Panic Disorder

  • Intense fear and discomfort associated with physical and mental symptoms  including:  o Sweating, trembling, shortness of breath, chest pain, nausea   o Fear of dying or loss of control of emotions
  • Induces urge to escape or run away, and often results in seeking emergency help  Ex:  Hospital
  •    Frequently accompanied by major depressive disorder
  •    Twice as common in women as in men

 

 

Agoraphobia

  •    Severe, pervasive anxiety when in situations perceived to be difficult to escape from,  or complete avoidance of certain situations  Ex: Crowded areas, alone outside of  home, travelling in a bus or plane
  •    Often seen after onset of panic disorder

Twice as common in women as in men

 

Social Phobia

  •    Marked, persistent anxiety in social situations  Ex: Public speaking
  • Possibility of embarrassment or reticule is crucial factor
  • Individual is preoccupied with concern that others will notice the anxiety symptoms  Ex: Trembling, sweating, halted-rapid speech
  •     Accompanied by anticipatory anxiety days or weeks prior to the feared event
  •    More common in women than in men

 

Obsessive-Compulsive Disorder

  •    Obsessions, such as recurrent thoughts or images that are perceived as  inappropriate or forbidden, elicit anxiety
  •    Individual perceives loss of control, thus acts on impulses or thoughts
  • Compulsions, including behaviors or thoughts, reduce anxiety associated with  obsessions  o Incudes overt behavior  Ex: Hand washing  and mental acts  Ex: Counting,  praying

o Take long periods of time to complete

  •    Disorder has fluctuating course, including periods of increased symptoms, usually  linked with life stressors
  •    Equally common in women and men

 

 

Generalized Anxiety Disorder

  •      Defined by worry lasting more than six months, along with multiple symptoms  Ex:

Muscle tension, poor concentration, insomnia, irritability

  •    Anxiety and worry not attributed to other conditions  Ex: Panic disorder, phobias
  •    Disorder has fluctuating course, including periods of increased symptoms, usually  linked with life stressors
  •    Twice as common in women as in men

 

 

Post-Traumatic Stress Disorder

  •    Anxiety and behavioral disturbances following exposure to extreme trauma  Ex:  Combat, physical assault , which persists for more than one month
  •    Dissociation, symptom involving perceived detachment from emotional state or  body, is critical feature
  •    Symptoms also include generalized anxiety, hyper-arousal, avoidance of situations  that trigger memories of trauma, recurrent thoughts  Occurs in about 9  of those exposed to extreme trauma

 

 

Prevalence of Anxiety

  • National Comorbidity Survey  o 18.1  of U.S. adult population will have a diagnosable anxiety disorder   o Of those individuals diagnosed, 22.8  are categorized as serious, 33.7  as  moderate, and 43.5  as mild
  • U.S. Department of Health and Human Services  o 16.4  of population will have an anxiety disorder  

 

Costs of Anxiety

  • Economic burden in terms of treatment and lost productivity   o Approximately one-third of costs are for psychiatric treatment  o Approximately one-half of costs are for non-psychiatric medical treatment  o 10  of costs are indirect expenses

o 5  of costs are for prescriptions and mortality costs  anxiety-induced  suicide

  •     Drug and substance abuse adds to the costs

 

Symptomatology 

  •     Unpleasant feelings  uncertainty, feeling overwhelmed
  •    Bodily symptoms  muscle tension, autonomic hyperactivity
  •    Changes in cognitions  obsessions, compulsions, irrational fear of objects or  situations
  •     Changes in behavior  avoidance of situations
  •    Vigilance  looking out for a problem

 

Clinical Anxiety vs. “Normal” Anxiety

  •     Anxiety is characterized by worry, self-doubt, nervousness, and tension
  •    When anxiety disrupts thought processes and behavior so much that normal  behavior is disrupted, it becomes clinical
  •    Clinical anxiety is distinguished from “normal” anxiety is based on the number and  intensity of symptoms, degree of suffering, and degree of dysfunction

 

Treatment

Medications: Tranquilizers and antidepressants

  • Effective but can be costly
  • Have side-effects
  •   Psychotherapy: Cognitive-behavioral therapy  CBT  for coping strategies
  • Can be costly o Can be time consuming
  •    Physical Activity: A potential tool in both the prevention and the treatment of  anxiety

Note: All three treatments may be combined

 

Measuring Anxiety

  • State Anxiety: A transient emotional state characterized by feelings of apprehension  and heightened autonomic nervous system activity  increased heart rate, sweaty  palms, increased breathing rate, increased muscle tension   o Usually assessed after single bouts of exercise
  • Trait Anxiety: A more general predisposition to respond with apprehension, worry,  and nervousness across many situations  lack of confidence, difficulty making  decisions, feelings of inadequacy   o Usually assessed after chronic exercise  i.e. after an exercise program

 

Psychological and Physiological Measures of Anxiety

  •     Psychological Measures:

o Self-report inventories

  • Physiological Measures:   o Muscle tension, via electromyography   o Blood pressure and heart rate   o Skin responses  o EEG  Electroencephalography

Note: It is best to incorporate both types of measures when measuring anxiety

 

Research on Preventative Effects of Exercise

  •    Greater self-reported physical activity is associated with better mental health, and  fewer symptoms of anxiety  Stephens, 1988
  •    Goodwin  2003  concluded that there is a potential link between regular exercise  and a reduced likelihood of a variety of anxiety disorders
  •    Higher levels of physical activity are sometimes related to lower self-reported  anxiety  Brunes et al, 2013
  •    Individuals who are physically fit have less anxiety than their unfit counterparts   Landers and Petruzzello, 1994

Research on Use of Exercise as a Treatment

  • Initially low-fit and highly anxious individuals have the most to gain from exercise  training
  •    Both anaerobic and aerobic training resulted in significant psychological  improvements  Martinsen, Hoffart, and Solberg, 1989
  •        Significant relationship has been noted between aerobic capacity and anxiety levels,  with greater fitness levels related to lower anxiety  Sexton, Maere, and Dahl, 1989   –      Vigorous exercise is not necessarily for improvements  Sexton, Maere, and Dahl,  1989
  • In patients with panic disorder:  o Pharmacotherapy  medication  is most effective, but exercise results in  significant improvement  Broocks et al., 1998

o Patients show significant anxiety reductions following exercise  O’Connor,  Smith, and Morgan, 2000

 

Relationship Between Exercise and Anxiety

  • Aerobic Exercise:  o Anxiety reduction  o No difference between modes
  • Reductions in state anxiety following acute exercise and in trait exercise following chronic exercise
  • Reductions are seen in self-reports and measures of muscle tension, the cardiovascular system, and the central nervous system

 Resistance Training:  o May result in slight increases in anxiety  that are very short-lived and return  to baseline levels relatively quickly  

  • Acute Exercise:  o Effect does not last indefinitely; lasts for 2 to 4 hours  o Anxiety returns to pre-existing levels
  • Possibility that over time pre-exercise levels of anxiety may become reduced

 Exercise vs. Other Treatments:  o Exercise has been shown to be better than not doing anything and is as  effective as other treatments  and it costs less  

  • Exercise many be more effective than anti-anxiety drugs

 

 

Consensus Statements Regarding Exercise and Anxiety

  •     Exercise can be associated with reduced state anxiety
  •    Long-term exercise is usually associated with reductions in neuroticism and trait  anxiety  neuroticism is mentioned because people with anxiety usually show some  traits of neuroticism
  •     Exercise can result in the reduction of various stress indices
  •     Exercise can have beneficial emotional effects across all ages and both genders

 

What We Don’t Know About Exercise and Anxiety

  • Intensity levels of exercise  o More research is needed on recommendations of minimal exercise intensity  levels
  •    Duration of exercise
  • Some research shows that durations of less than 20 minutes were as effective as those greater than 20 minutes
  • Anxiety reduction seems to be achieved regardless of duration

 

Mechanisms of Change

  •    Thermogenic Hypothesis
  •     Distraction-Time-Out Hypothesis
  •    Other possible mechanism of change are similar to those proposed in previous  chapter  ex: mastery, self-determination

 

 

Thermogenic Hypothesis

  •    Elevated body temperature resulting from exercise may lead to psychological  changes such as reduced anxiety
  • The brain senses the temperature increase ! leads to muscular relaxation response  ! feeds back to the brain ! interprets the muscle response as relaxation or reduced  anxiety
  •    It could be brain temperature, not body temperature, that drives the affective  response

 

Distraction-Time-Out Hypothesis

  •    The anxiety-reducing effects of exercise may be due to the distraction it provides  from one’s normal routine
  •    An anxious or depressed individual who exercises is taking a “time-out” from  his-her worries and concerns

 

Practical Recommendations

  •    Exercising on a regular basis does seem to be useful in reducing-treating anxiety,  although the minimal level required is unknown
  •     Aerobic forms of exercise seem to be most effective
  • Individuals with more severe forms of anxiety should consult a mental health-care  provider