Anxiety disorder

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Anxiety disorder affects children and young adults who are distressing particularly in a social setting and hinder a person’s social tolerance. Individuals with social anxiety disorders are facing intrinsic difficulties in a social setting that needs personal contact, evaluation or attention. In any case, however, it indicates the patient’s expectation or duty to communicate with other people and that it is calculated on the basis of those interactions. Cognitive behavior can be determined through the application of the socio-cognitive perspective and functional assessment perspective (Morgan 2003). The socio-cognitive approach examines individual social interactions, experiences and influence of outside media with a view of determining how they influence cognitive behavior. The functional behavior assessment perspective aims to determine the rationale of behavior and posits that behavior is often linked to a defined outcome.

Anxiety disorder commonly known as social phobia is a critical health problem that inhibits performance in a social situation making it difficult for a patient to communicate or associate with other people. However, it is critical to differentiate between a person suffering from social anxiety disorder and a shy person. Essentially a shy person may be reluctant to engage others in a social situation, but once they have adapted to their immediate social situation, they become increasingly comfortable and are able to socialize effortlessly. However, this is not the case for teensand young people suffering from social anxiety disorder given that they illustrate high levels of fear and anxiety if an attempt is made to place them in a social environment.

Literature Review

Borkovec and Costello (2012) document their research on “Nondirective (ND), applied relaxation (AR), and cognitive behavioral (CBT) therapies for generalized anxiety disorder (GAD).” The researchers took into consideration recent studies that were conducted with the aim of finding the nature of generalized anxiety disorder. As a result, the research was conducted through the use of “controlled outcome investigation with a methodology and design that would hopefully allow unambiguous elimination of two of the most likely rival hypothesis in prior studies” (Borkovec & Costello, 1993).

The research study describes the methods used in the study including the selection of qualifying subjects. Out of “508 clients referred to from agencies and news advertisements” (Borkovec & Costello, 1993); only 55 qualified to remain in the study and they averaged 37.5 years. In this group the average duration within which the candidates had the problem was 17.1 years. In addition, ethnic composition included “51 white, 2 black, 1 Hispanic and 1 Indian” (Borkovec & Costello, 1993). The ratings for the selection process and assessment outcomes were conducted through “30 minute phone interviews and subsequent diagnostic interview use the anxiety disorders interview schedule” among other testing measures (Borkovec & Costello, 1993).

The self-report outcome measures included clients filling a diary thrice on a daily basis for a period of two weeks before the commencement of therapy. This included follow-ups and post assessment tests. At the end of each process, various measures were made to determine the extent within which the clients indicated general anxiety disorder on the basis of various factors including empathy and therapies warmth. These process measures sought to determine the client’s response to various factor such as social and environmental factors. Therapists and therapy conditions were also critical in the attainment of optimal results and success of the research. Therapy conditions were varied to ensure that the clients’ responses to various therapy conditions were measured.

The results of the various tests and measures were subjected to various and vigorous statistical and mathematical analysis with the aim of arriving at an accurate interpretation of the results. The results were interpreted and evaluated according to preliminary analyses, post assessment improvement between group change, within-group change, clinically significant change, follow-up improvement, between-groups change and within-group change. This also included measures such as clinically significant change, drug status, and credibility, “therapeutic relationship measures and experiencing scale” (Borkovec & Costello, 1993).

The overall outcome of the study indicated that “applied relaxation and cognitive behavioral therapies” had better outcomes in contrast to the use of nondirective therapies; more so at post assessment (Borkovec & Costello, 1993). Consequently, Borkovec and Costello conclude that their results “indicate the permanence of change provided by AR and CBT and are suggestive of potentially enhanced improvement in end state functioning for CBT at long-term follow-up” (Borkovec & Costello, 1993). However, this results are subject to change in future studies that place significance emphasis on the presentation attributes of general anxiety disorder give changes in factors such as efficacy.

Though the results obtained from the study are satisfactory, “applied relaxation and cognitive behavioral therapies” techniques continue to evolve; hence improving “the treatment of generalized anxiety disorder on a continuous basis” (Borkovec & Costello, 1993). Essentially, the author’s determined that the integration of these therapies through the incorporation of techniques that target each system would significantly enhance efficacy. However, the study’s result are not conclusive but offer a basis within which further studies can be conducted with the aim of establishing the optimal integration of “relaxation and cognitive therapies in the treatment of general anxiety disorder” (Borkovec & Costello, 1993) . However, the author’s argue that integration of therapies should not be limited to cognitive behavioral therapies, but should be adopted in various therapies for optimal results.

In a study conducted by Compass et al. (2001), they identified the issues that influence “coping with stress during childhood and adolescence.” The study integrates various literature reviews in studying the various aspects of coping with stress; significantly, the concept of coping with stress is comprehensively defined with a view of previous research and the context of the study. This is because most research has been conducted without the “explicit definition of coping”; therefore, “characteristics of children’s responses that have been included within the concept of coping in one investigation have been excluded from another” (Compass et al., 2001).

Among the definitions of coping that have been described is, “how people regulate their behavior, emotion, and orientation under conditions of stress.” However, various concepts are integrated into the coping mechanisms such as resilience and coping which are integrated to reflect unique aspects of success in the development and adaptation of “coping with stress in childhood and adolescence” (Compass et al., 2001). The literature review in the study demonstrates that while there are various causal factors that contribute towards the development of stress in childhood and adolescence, dynamic environmental and psychological factors make vital contributions in the coping process.

Therefore, the adoption of various strategies including coping and development are critical in mapping the dimensions and subtypes of coping with stress. Evidently, numerous factors must be considered in the coping processes of children and adolescents in contrast to adults; for instance, the differentiation between engagement and disinterment coping is essential in order to isolate the cause of the stress and developing responses that are “oriented away from the stressor or one’s emotions or thoughts” (Compass et al., 2001).

They used questionnaire summaries in its measurement of coping strategies. Statistical and mathematical analysis were used in the interpretation of the data; hence producing results that are reliable. Other research methods that were integrated in the study included observational methods, interview measures of coping and assessment of methodological issues in coping assessment. It is evident that significant focus in the design of the study is critical in the attainment of its objectives; therefore, the authors reiterate that the study design must be undertaken with care in order to prevent the occurrence of erroneous data, misinformation and wrong information.

Coping with stress significantly depends on the stressors such as personal illness, sexual abuse, parental divorce, natural disaster among others. These stressors have been identified by various research studies as the literature review indicates; therefore, the coping strategy adopted must first identify the primary stressor. This ensures the optimal approach towards the management and coping strategies of stress are applied.

The authors grouped the studies that were reviewed in the study according to their “categories of problem and emotion-focused coping and engagement-disengagement coping” (Compass et al., 2001). The study found that problem focused strategies entailed seeking information, solving problems and support that focused on problems; whereas, coping mechanisms that focused on emotions included denial and expression of emotions. Meanwhile, “engagement coping” included seeing support, expressing emotions and problem solving while “disengagement coping included cognitive avoidance, social withdrawal and problem avoidance” (Compass et al., 2001).

The study determined “large body of literature” exists that documents the “nature, characteristics, and correlates of coping during childhood and adolescence” (Compass et al., 2001). Furthermore, there have been advances in the “conceptualizations of coping and critical measures have been created” in dealing the stress among young people (Compass et al., 2001). The literature review of the various research studies in the study illustrates that there numerous findings that can be used in coping strategies. However, while the research has made significant findings, various issues need to be researched further to ensure advances in the field are realized. The authors present the directions of future research indicating that a consensus is needed in the “conceptualization of coping in childhood and adolescence” and research needs to take social context seriously among other directions (Compass et al., 2001).

Cognitive Behavior for Anxiety among Teens

Social anxiety disorder is attributed to various causes that include environmental and genetic factors. Various researches have determined that a child’s genetic predisposition can have a significant impact on the development of reserved, repressed or inhibited traits that can result into social phobia if certain pressures and challenges occur. The impacts of environmental factors towards the presentation of social phobia have been linked to family dynamics (van Straten et al., 2007). Issues such as parenting, family environment, upbringing and experiences in life can influence the presentation of social phobia. In the event that parents or guardians of a child are socially repressed or exhibit anti-social behavioral tendencies, it is highly likely that the child will behave in a similar manner (Rapee & Heimberg, 1997).

If a teenager is exposed to a family situation that is averse to socializing or the creation of relationships outside the home, the chances are that they will develop social anxiety disorder causing them to become anxious whenever other people try to come close. Children and young people that are exposed to such parenting are likely to develop with the belief that socializing is precarious and places a person in potential danger of embarrassment or misjudgment (Schneier, 2003). The problem can also be caused if parents become excessively overprotective of their young especially when they meet with challenges in the social environment such as being rejected or failing to achieve a certain social goal (Rapee & Spence, 2004). Parents may dissuade a teenager from attempting to socialize asserting that they do not need to be acknowledged or recognized in the social context; hence create a subconscious disengagement and dissociation with the social setting. These issues result in a young person leading a life that is fearful of social interaction conceding that failure, criticism, or negative judgment is a pre-determined outcome (Rapee & Heimberg, 1997).

The examination of environmental and genetic factors that cause social phobia, it is prudent to acknowledge that the precepts of” multifinality and equifinality” are applicable in explaining the development process of social anxiety disorder (Rapee & Spence, 2004). Equifinality is a concept that implies that children and young people could be exposed to different upbringing, family and social backgrounds, yet they develop similar behavioral attributes. Meanwhile, multifinality asserts that teens brought up in the same family and social environment can lead different ad separate lives characterized by significant differences in social behavior (Morgan, 2003). Therefore, though a teenager may develop social phobia as a result of the family environment and upbringing factors, it does not necessarily mean that all teens in the family will develop the same problem.

There is a high probability that some of the teens will become more social and accept new people than others (Osman et al., 1998). This illustrates that divergent development pathways are possible for teens brought up in the same environment since some can adapt easily while others require more attention and effort to modify their behavior. Though a single event or factor can have a considerable impact in influencing behavior, it does not mean that it will influence the child’s overall social behavior and attitude (Kashdan & Steger, 2006). In the case of genetic causal factors, social phobia is developed as a combination of various personal traumas that inhibit an individual’s ability to socialize with others.

The development process in teens involves numerous experiences especially prior to attaining adolescent age where complex social development processes occur. These may include the establishment of independence and life goals or creation of new relationships. A young person’s success in developing such relationships or attainment of social goals is vital towards the development and enforcement of self-control, confidence, self-esteem and identification of socially acceptable behavior and attitudes (Osman et al., 1998). The presentation of social phobia is largely evident during the early adolescent age and has the potential to develop further is they develop “higher order of cognitive skills that endorse their capacity for comparative self-evaluation to others” (Rapee & Spence, 2004).

The identification of social phobia can be detected at an early age through the examination of a child’s social behavior. A child could present traits that indicate an aversion to social situations and unfamiliar faces, reduced communication and disengagement from social activities (Murray et al., 2008). Consequently, as the teens grow older, they become more averse to social situations that may require their active participation. Avoiding others through hiding or seeking familiar environments that are isolated from the social crowd is a common phenomenon. If parents or guardians fail to recognize these indicators of social phobia, it is highly likely that child would regress further.

In a clinical perspective, various behavioral responses in teens illustrate the presence or an emerging problem of social phobias such as aversion to eye contact with other people and a stuttering speech pattern. These are indicators of that demonstrate a failure to function adequately especially in social contexts (Boer, 1997). Consistent social dissociation, behavioral disengagement, panic attacks, somatic complaints and progressive tantrums are among the indicators of social anxiety disorder. The emergence of social phobia at an early age could result in additional mental and psychological problems that may not be foreseen but cause significant distress to the patient. A large number of young people suffering from social phobia have been found to present with additional problems including “severe depression, suicidal ideation and antisocial behavior” (Marcelp P, Marcelo T, Marco, & Daniele, 2003).

Though there may not be any distinctions in the presentation of social phobia between boys and girls; there are significant differences in the manner that they interpret their condition and react to the world. The presentation of social phobia in young girls is often associated with feelings of loneliness, fear, feelings of being secluded or left out and detachment from peers (Schimdt & Schulin, 1999). Meanwhile, boys suffering from social phobia feel they are not good enough, they are incompetent or inadequate and a “self-originated perceptual aversion from that of their peers” (Rapee & Spence, 2004). Though male and female young people feel differently as a result of social phobia, they present with common issues in the attainment of life goals since the presentation of social phobia limits their vocational choices. These can result in economic and health challenges considering that social phobia is associated with low levels of self-esteem, sensitivity to subjective judgment or evaluation.

Integrative treatment Approach

The integrative treatment approach takes into consideration socio-cognitive perspective and functional behavior perspective. Hence, the development of cognitive and behavioral therapy approaches. The utilization of an integrative therapeutic model emphasizes on affirming each person’s unique and integral values. In essence, this is the combination of various systems such as behavioral, cognitive and physiological systems with the aim of providing a holistic therapy to a client presenting dynamic psychological issues (Robertson, 2010). In essence, the integrative therapeutic considers varied perspectives of the human functions. Since various therapeutic models address a distinct aspect of the human behavior and psychosis, integration enhances the ability of therapeutic models to address the issues more accurately. Since other factors that contribute to a client’ issues may not be addressed by a defined approach, the integration of various models enable such factors to emerge and are resolved accordingly (Robertson, 2010).

The two models of therapy that can be integrated include behavioral therapy and cognitive therapy. The difference between these therapies is that the behavioral therapy is focused on modification of human behavior through identification of the maladaptive behavior (Robertson, 2010). The identified deviant or unwanted behavior is modified through various techniques such as positive reinforcement, classical or operant conditioning. This approach is used to address mental health issues that lead to the development of unwanted behavior.

For instance, behavioral therapy can be used to treat anxiety, addiction, and phobias among other behavioral issues. Meanwhile, cognitive therapy focuses on individual perceptions, thoughts and ideologies that influence attitudes and behavior (O’hea, Houseman, Bedek, & Sposato, 2009). As such, cognitive theory attempts to restructure negative perceptions and thoughts with the aim of enabling a client to develop and enhance positive thinking in a flexible criteria that ultimately leads to modification of behavior.

Since, thoughts, perceptions, feelings, attitudes and behavior are integrated in various ways, the identification, isolation and elimination of negative thinking, distressing behavior and emotional responses can have significant impacts in enhancing mental health (O’hea, Houseman, Bedek, & Sposato, 2009). Though these two theories differ in that behavioral therapy addresses deviant behavior while cognitive therapy addresses deviant perception, thinking, and feelings, they are similar in that their outcomes have an impact on overall modification of behavior. Therefore, the objective of the two therapies culminates changes in the client’s behavior.

The treatment of social phobia is dependent on how early the problem was detected and the measures that were taken to mitigate the problem. The application of cognitive-behavioral therapy has been found to solve the problem in most cases especially if administered in continuous processes (Morgan, 2003). The cognitive therapy integrates training on the application of social skills towards aiding them to confront their phobia and develop effective and reliable coping mechanisms. In addition, psychotherapies are also administered, and medications may be prescribed to reduce the level of anxiety. Medication can be prescribed to reduce social anxiety disorder; however, they can only be relied on to a certain degree, and other methods must be included in the overall treatment plan.

Faith Integration

In instances that the caregiver such as nurse or physician professes a different faith from that of the patient, it is critical that the care provider beware of the difference. The nurse or physician must be careful not to offend a patient’s religion or belief system; therefore, they must be sensitive and provide care according to the patient’s faith (Hollins, 2009). Medical professionals must attend to the medical needs of all patients irrespective of their religious beliefs. In light of this, patients need not worry that the medical and care professionals will infringe on their religious beliefs. A doctor will always be sympathetic to the patient’s religion through compromise and adherence to professional etiquette (Hollins, 2009). The patient’s needs must come first before those of the caregiver.

Religious patients will worry that the conflict between their religion and that of caregivers may result in compromised medical attention. Therefore, it is critical for caregivers to let go of their faith and incorporate the patients’ belief system in the healing process. The incorporation of the patient’s faith makes them re-assured that the caregiver will not be influenced by prejudices or biased attention on the premise of existing differences between the religions (Hollins, 2009).

Caregivers cannot allow their own religious precepts to interfere with their work because most patients prescribe to differing religious viewpoints that conflict with theirs. According to the interviews, it is evident that a caregiver who took the patients faith into consideration had a significant impact on the patient’s healing process. Therefore, the creation of a healing environment that acknowledges respects and upholds the patient’s religious beliefs facilitates a holistic healing paradigm. In essence, this creates an environment that caters for the spiritual, physical and psychological healing creating the optimal care environment for patients.

Conclusion

Social anxiety disorder is a problem that can impair a child’s life if it remains unaddressed. It has the impact of reducing the quality of life since a child or young person feels a sense of isolation and disengagement from the normal social environment. Encouraging the development of social skills is vital towards especially in challenging social situations. Instances of failure or criticism should be taken as learning milestones and not causes to avoid social interaction. Parents play a significant role in ensuring that their teens develop adequate social skills through encouragement and participation. Though there are various cognitive therapies and medication for social phobia, the identification of a problem at very early age can enable the parent to help the child develop social skills that prevent the problem from occurring.

References

Boer, J. A. (1997). Social Phobia: Epidemiology, Recognition, and Treatment. BMJ: British Medical Journal, 315(7111), 796–800.

Borkovec, T. D., & Costello, E. (1993). Efficacy of Applied Relaxation and Cognitive—Behavioral Therapy in the treatment of Generalized Anxiety Disorder. Journal of Consulting and Clinical Psychology, 61(4), 611-619.

Compass, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological Bulletin, 127(1), 87-127.

Hollins, S. (2009). Religions, Culture and Healthcare: A practical handbook for use in healthcare environments. 2nd ed. Abingdon, UK: Radcliffe Publishing Ltd.

Kashdan, T. B., & Steger, M. F. (2006). Expanding the Topography of Social Anxiety: An Experience-Sampling Assessment of Positive Emotions, Positive Events, and Emotion Suppression. Psychological Science, 17(2), 120–128.

Marcelo P. F. Marcelo T. B., Marco A. C., & Daniele P. P. (2003). # 1593/Quality of Life in Outpatients with Depression Comorbid with Social Phobia. Quality of Life Research, 12(7), 782–782.

Morgan, S. (2003). “Phobia: A biological perspective.” In: Encyclopedia of psychoanalysis: Phobia: A reassessment. London, UK: Karnac Books.

Murray, L., de Rosnay, M., Pearson, J., Bergeron, C., Schofield, E., Royal-Lawson, M., & Cooper, P. J. (2008). Intergenerational Transmission of Social Anxiety: The Role of Social Referencing Processes in Infancy. Child Development, 79(4), 1049–1064.

O’hea, E., Houseman, J., Bedek, K., & Sposato, R. (2009). The use of cognitive behavioral therapy in the treatment of depression for individuals with CHF. Heart Failure Reviews, 14(1), 13-20.

Osman, A., Gutlerrez, P. M., Barrios, F. X., Kopper, B. A., & CHiros, C. E. (1998). The social phobia and social interaction anxiety scales: Evaluation of psychometric properties. Journal of Psychopathology and behavioral assessment, 20(3), 249-264.

Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review 27(7), 737-767.

Rapee, R. M., Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behavior Research and Therapy 35(8), 741-756.

Robertson, D. (2010). The philosophy of cognitive-behavioral therapy (CBT): Stoic philosophy as rational and cognitive psychotherapy. London, UK: Karnac Books Limited.

Robichaud, M., (2010). Cognitive therapy of anxiety disorders: Science and practice. Canadian Psychology, 51(4), 282-283.

Schimdt, L.A., & Schulin, J. (1999). Extreme fear, shyness and Social Phobia. New York, NY: Oxford University Press.

Schneier, F. R. (2003). Social Anxiety Disorder: Is Common, Underdiagnosed, Impairing, And Treatable. BMJ: British Medical Journal, 327(7414), 515–516.

van Straten, A., Cuijpers, P., van Zuuren, F. J., Smits, N., & Donker, M. (2007). Personality Traits and Health-Related Quality of Life in Patients with Mood and Anxiety Disorders. Quality of Life Research, 16(1), 1–8.

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