Disorder Paper - Anxiety
Jonathan Dimitroff University of Phoenix
Psych 575
March 23, 2015
Leah Mancuso PhD

Disorder Paper - Anxiety
The purpose of this paper is to discuss a neurological, psychological, or neurodevelopmental disorder. It is to compare and contrast three therapeutic interventions used to treat the chosen disorder; comparing measures of effectiveness, such as validity, efficacy, symptom and behavior management, and recidivism. One therapy should be cognitive in nature, one pharmacological in nature, and the third should be an alternative therapeutic treatment. This paper will identify common symptoms associated with the disorder, and rates of symptom reduction or management as reported with the three treatments. It will discuss what approach this author would use to treat this disorder based on the research used to develop this paper; and why. It will also analyze the neurophysiological underpinnings of disorders and diseases, as well as examine contemporary attitudes towards the three treatments selected.
For the purposes of this paper, anxiety will be the chosen disorder. It is a psychological disorder with a variety of symptoms and specific types of anxiety. To list a few of the different types of anxiety, there is Panic disorder, Obsessive-Compulsive disorder, Post-Traumatic Stress Disorder, Social Anxiety disorder, then there are the phobias which fall under the anxiety label, as well as Generalized Anxiety disorder. When one mentions anxiety, it is good to know exactly which type of anxiety one is speaking about, since there are so many different types. Still, many of the symptoms of each type are similar to those experienced in other types, namely a feeling of fearfulness and uncertainty. With panic disorder, those feelings are multiplied to the point of feeling as though one cannot breathe, there is an overwhelming sense of fear and dread, though usually that fear and dread are of some unknown, or unknowable – something ( Bertisch, Long, Langebahn, Diller, & Ashman, 2013).
The three therapeutic interventions chosen for this paper are medications, Cognitive-Behavioral Therapy, and Forgiveness Therapy. Since anxiety and depression seem to exist hand in hand, partly because when one is anxious and fearful for an extended period of time, one tends to get depressed, and one wonders if one will ever feel normal again, one of the primary medications used to treat anxiety is antidepressants. Antidepressants can take four to six weeks to get fully integrated and one begins to notice a lessening of the symptoms. SSRIs, or selective serotonin reuptake inhibitors alter the level of the serotonin in the brain. Serotonin is a neurotransmitter which helps in the communication between brain cells. By inhibiting the reuptake they allow for better communication between on brain cell and the next.
Watson, O’Hara, Simms, Kotov, Chmielewski, McDade-Motez, Gamez, & Stuart (2007) created an inventory of depression and anxiety symptoms, which, after reading their article it seems they came to the grand conclusion that there is no single higher order factor that fits nicely into one category or the other, but there is a much more complex structure that needs further investigation. In the course of developing and validating their IDAS they used several different tests to ensure the validity and reliability of their hypothesis. They also questioned some of the terms used in the DSM-IV because the measures used there did not seem appropriate to the criteria being used. For example, the use of hypersomnia as a marker for depression and anxiety seems incorrect, as it appears to be more consistent with Lassitude. The IDAS was designed to complement and enhance current measures of the symptoms of anxiety and depression (Watson et al, 2007).
The cognitive treatment chosen for this paper is CBT, which is an intense program where the client has to participate in group meetings, and in one-on-one sessions with the therapist. During the course of CBT the clients will discuss what they are feeling and try to explain why they are feeling that way. In addition to the meetings there is homework that one must do; and it is this homework, and the willingness to do the homework that are determining factors in the effectiveness of CBT. While this author was involved in a CBT program he was forced to be brutally honest with his therapist, and most importantly, with himself. If one is not willing to do so, one may as well move on to a different type of therapy, or give up entirely, since the whole point of any psychotherapy is to get into how a person thinks, and find out why, something that cannot be accomplished without total honesty (Glen, Rose, Stein, Bystritsky, Golinelli, Roy-Byrne, Sullivan, Sherbourne, & Craske, 2013).
Glen et al (2013) suggest that dose and engagement, or time and effort spent in therapy meetings, and doing the homework can lead to great success rates if one puts forth enough time and energy. In the program that this author was involved with, the clients had to attend group meeting daily M-F for two hours, plus individual meetings with the therapist a minimum of monthly, more often if needed, and spend at least an hour a day, if not more, doing homework, which was turned in to the therapist, who would read it, and then provide questions based on one’s responses, thereby creating a sort of dialogue through the homework, and the notes attached to it. This homework could range from a detailed autobiography to answering questions about emotions, such as anger, or fear, and what they mean to the client, when was the first time the client remembers feeling these emotions. It could be very time intensive, but if one was willing to do the work, one could learn to accept alternatives to how one thought in given situations.
It should be noted that the study by Glen et al (2013) suggests that more study should be done on whether more time and effort over a series of exposures is more effective than the time and effort involved in one exposure. This author can attest to the effectiveness of CBT in the program in which he was involved; and while it was not specifically designed to address anxiety, anxiety issues were addressed to some extent, and the recidivism rate of the clients was much higher than the rest of the population. The program’s success rate was such that they had a 4% recidivism rate, whereas the rest of the DoC population had a 70% recidivism rate within the first three years after release. If one can transfer that over to just anxiety and depression then one can assume that the effectiveness of CBT would be as high, if not higher than that of either medications, or Forgiveness Therapy.
Forgiveness Therapy is a treatment option used with the victims of spousal abuse. The victims are predominantly women, and they often suffer anxiety, depression and low self-esteem as a result of the abuse. Spousal abuse involves far more than just physical abuse, often there is emotional and mental abuse as well (Reed & Enright, 2006). One key factor in this is defining forgiveness, and differentiating forgiveness from condoning, or excusing the wrongs done to the victim. In this sense forgiveness is simply a decision to let go of resentment, and respond with a desire for the best for the abuser. This don not mean that one has to forget the wrongs done, or pardoning them, and it definitely does not mean one has to try to get back together with the abuser, it simply means that one learns how to forgive, because holding onto resentment can hinder the healing process.
In this study it was shown that FT has an overall effect on emotional stability, reducing anxiety and increasing self-esteem, and promoting an ability to make more reasoned decisions. Since this study was done using only women as participants, it would be interesting to see how effective this would be with men.
All three treatments claim high rates of success, and validity, with efficacy playing a large part in the success of the treatment, if one does not belief the treatment will work, then there is every chance that it will not. This in part relates to a study by Cheng, Cheung, Chio, & Chan (2013) which talks about the Locus of Control, and how one perceives the outcomes of events as being the results of either their own actions or the actions of others. In other words those with an internal LOC act upon the world, whereas those with an external LOC are acted upon by the world. With this in mind, it is important to get an internal LOC in order to begin a productive treatment program, because if one relies solely on the efforts of others, one will surely fail. This study concludes that while LOC is not a new construct, it definitely deserves more study.
Within the realm of treatment it is okay to depend on a therapist to direct one towards the desired goal, but one has to put forth the time and effort to achieve the goal one has in mind at the onset of treatment. If one is using medications to achieve the desired effect then one has to invest the time to allow them to work, and to get the most out of them. If they do not have the desired effect within a reasonable timeframe, it may be necessary to increase the dosage, and again one then has to wait for a balance to be reached. Since there are so many drugs on the market that can be used to treat anxiety, it may be necessary to try several to find the one that offers the best outcome.
CBT has a high rate of success with many psychological issues simply by making the client address those issues in their own terms, and realizing that much of those issues is caused by how they think about certain things. For instance if one has severe anxiety about talking in public, it is simply a matter of finding out why and learning to think in such a way as to lessen the anxiety, this can be through something as simple as thinking of the audience as being in their underwear, or it may involve learning to think that one is more knowledgeable about the subject at hand, and thus one can feel better about one’s ability to speak with authority.
FT seems to work for the women chosen to participate in the study, and decreases anxiety and depression while bolstering confidence and self-esteem. It seems to be an effective treatment option for victims of spousal abuse and offers long-term results as far as anxiety, depression and self-esteem issues are concerned.
Bondi (1992) contends that many psychologists are not qualified to differentiate between psychological disorders from neurological disorders. His article goes into how certain psychological issues may be brought on by a neurological component, which, if that is the case, it may take longer to discover this if one is not proficient in the subset of professional skills. Neuropsychiatrists are trained in both neurology and psychiatry, and so have an advantage over just a psychologist in determining if there is a neurological aspect to the presenting psychological issue. Some forms of anxiety can be brought on by acquired neurological damage from an accident, or from abuse from others, there are several causes which can cause damage to the brain, and thus cause a person to exhibit a psychological problem, but in reality that problem is being cause by a neurological issue which also needs to be addressed.
In many cases there is a neurological issue which needs to be addressed; in depression and anxiety, there is usually a chemical imbalance which can be addressed with medication. The use of SSRIs or SNRIs can be very effective in reducing anxiety and depression simply by restoring that chemical balance, but it is neurological factor that one might miss if one only relies on CBT or FT to treat the anxiety issues. Bondi (1992) suggests that many psychologists are not adequately trained to detect the fine, and hard to see underlying neurological causes of the disorder.
In many diseases and disorders there is an underlying neurological cause which may go unnoticed until one is passed on to a specialist. For instance being in a car accident, one can sustain considerable damage to the brain just from being thrown around inside the car, and having one’s head bounce off the window, or hit the steering wheel, yet that damage may not be evident until one notices changes in one’s behavior, changes which cannot be explained readily. Suddenly developing a seizure disorder may be indicative of a neurological issue, such as a tumor in the brain. These are just a couple of examples that come to mind, but there are many other disorders and diseases that have a neurological cause, but are treated as psychological issues until the therapist is convinced that treatment is ineffective, and begins to seek for answers as to why it is not working.
Contemporary attitudes towards these three treatments vary, medication is one of the first options chosen by doctors and psychiatrists for anxiety, and while this is usually quite effective, some clients do not want to be stuck taking a medication for the rest of their lives, especially when some of those medications can run into the hundreds of dollars for a one month supply. For many it is better to seek another alternative, or just be anxious than to constantly be under that kind of financial burden. CBT is an effective option that is looked upon with respect by most therapists and counselors. It offers long-term results that come at the expense of time and effort one the part of the client, and there is a correlation between the amount of time and effort spent by the client and how well CBT works. If one approaches it as a joke, and only wants to spend the least amount of time possible, then one is not going to get the same results as someone who spends considerable more time in group meetings, seeking additional one on one time with the therapist, and doing the required homework, which can be very time intensive. FT is something relatively new which seems to work with the women involved in the study, but it has yet to be looked at by the psychology community as a whole, or if it has been, there is not much feedback on it yet. The purpose of this paper was to examine a neurological, psychological, or neurodevelopmental disorder, in this case anxiety was chosen. It was to compare and contrast three interventions used to treat this disorder, comparing measures of effectiveness, such as validity, efficacy, symptom and behavior management, and recidivism. It was to identify common symptoms associated with the disorder and rates of symptom reduction with each of the three treatments, and which of these, based on the research done would this author choose to use, and why. So far all of these have been addressed except the last bit, which, if it were up to this author, he would suggest using a combination of medication and CBT; using the medication as an immediate source of help in bringing the client relief, but then using the CBT to see if perhaps a nonchemical answer can be found. If it is simply a chemical imbalance, then yes, medication is probably going to be an ongoing course of treatment, but it there is a chance to relieve some of the anxiety through cognitive-behavioral therapy, then that is certainly worth investigating. If there is an alternative to the medications offered by the big drug producers then that may bear looking into as well.

References
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