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One cause of separation anxiety in canines is chronic stress. A study in 2012 tested nelumbinis semen, the seeds of the herb "Nelumbo nucifera", and its anti-depressant effects on animals experiencing stress. It should be noted that this study did not test directly on canines, but rather rats, and aimed to apply the principles found by the study to other animals such as dogs. The study, however, did test oral toxicity specifically on canines. After testing different dosage amounts of the nelumbinis semen, scientists determined that 400 mg per the animal's weight in kilograms was the most ideal amount to lower immobility when the animal was faced with a stressful situation. In addition, nelumbinis semen was not found toxic when administered to dogs. Based on these findings, it is possible that if more research was put into studying herbal remedies such as nelumbinis semen, it is possible that alternative and "natural" ingredients could be used as a substitute for drug-based therapy.
The most common adverse effects related to fluoxetine treatment were decreased appetite, experienced by 23% of the dogs in the study, and lethargy, experienced by 39% of the dogs in the study. Some canines actually experienced worsening anxiety and aggressive behavior.
In the study with clomipramine, 9 dogs underwent withdrawal after discontinuing treatment. 5 of those dogs were successful in overcoming the withdrawal, while 4 dogs relapsed. With regards to these results it is important to note that these sample sizes were relatively small. However, these studies have given us a look at one of the many variables regarding psychoactive drug withdrawal.
With regards to benzodiazepine treatment, it has been found that canines can develop dependence to these types of medications and go through a similar withdrawal process as humans. For example, their seizure threshold is lowered and anxiety relapse can occur after stopping benzodiazepine treatment. Similarly to treatment of human anxiety disorders, benzodiazepines are a last resort treatment, due to their addiction potential.
The use of medication is applied in extreme cases of SAD when other treatment options have been utilized and failed. However, it has been difficult to prove the benefits of drug treatment in patients with SAD because there have been many mixed results. Despite all the studies and testings, there has yet to be a specific medication for SAD. Medication prescribed for adults from the Food and Drug Administration (FDA) are often used and have been reported to show positive results for children and adolescents with SAD.
There are mixed results regarding the benefits of using tricyclic antidepressants (TCAs), which includes imipramine and clomipramine. One study suggested that imipramine is helpful for children with “school phobia,” who also had an underlying diagnosis of SAD. However, other studies have also shown that imipramine and clomipramine had the same effect of children who were treated with the medication and placebo. The most promising medication is the use of selective serotonin reuptake inhibitors (SSRI) in adults and children. Several studies have shown that patients treated with fluvoxamine were significantly better than those treated with placebo. They showed decreasing anxiety symptoms with short-term and long-term use of the medication.
Focus is increasing on prevention of anxiety disorders. There is tentative evidence to support the use of cognitive behavior therapy and mindfulness therapy. As of 2013, there are no effective measures to prevent GAD in adults.
Many other remedies have been used for anxiety disorder. These include kava, where the potential for benefit seems greater than that for harm with short-term use in those with mild to moderate anxiety. The American Academy of Family Physicians (AAFP) recommends use of kava for those with mild to moderate anxiety disorders who are not using alcohol or taking other medicines metabolized by the liver, and who wish to use "natural" remedies. Side effects of kava in the clinical trials were rare and mild.
Inositol has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder. There is insufficient evidence to support the use of St. John's wort, valerian or passionflower.
Aromatherapy has shown some tentative benefits for anxiety reduction in people with cancer when done with massages, although it not clear whether it could just enhance the effect of massage itself.
Non-medication based treatments are the first choice when treating individuals diagnosed with separation anxiety disorder. Counseling tends to be the best replacement for drug treatments. There are two different non-medication approaches to treat separation anxiety. The first is a psychoeducational intervention, often used in conjunction with other therapeutic treatments. This specifically involves educating the individual and their family so that they are knowledgeable about the disorder, as well as parent counseling and guiding teachers on how to help the child. The second is a psychotherapeutic intervention when prior attempts are not effective. Psychotherapeutic interventions are more structured and include behavioral, cognitive-behavioral, contingency, psychodynamic psychotherapy, and family therapy.
Appropriate medications are effective for panic disorder. Selective serotonin reuptake inhibitors are first line treatments rather than benzodiazapines due to concerns with the latter regarding tolerance, dependence and abuse. Although there is little evidence that pharmacological interventions can directly alter phobias, few studies have been performed, and medication treatment of panic makes phobia treatment far easier (an example in Europe where only 8% of patients receive appropriate treatment). Medications can include:
- Antidepressants (SSRIs, MAOIs, tricyclic antidepressants and norepinephrine reuptake inhibitors): these are taken regularly every day, and alter neurotransmitter configurations which in turn can help to block symptoms. Although these medications are described as "antidepressants", nearly all of them — especially the tricyclic antidepressants — have anti-anxiety properties, in part, due to their sedative effects. SSRIs have been known to exacerbate symptoms in panic disorder patients, especially in the beginning of treatment and have even provoked panic attacks in otherwise healthy individuals. SSRIs are also known to produce withdrawal symptoms which include rebound anxiety and panic attacks. Comorbid depression has been cited as imparting the worst course, leading to chronic, disabling illness.
- Antianxiety agents (benzodiazepines): Use of benzodiazepines for panic disorder is controversial with opinion differing in the medical literature. The American Psychiatric Association states that benzodiazepines can be effective for the treatment of panic disorder and recommends that the choice of whether to use benzodiazepines, antidepressants with anti-panic properties or psychotherapy should be based on the individual patient's history and characteristics. Other experts believe that benzodiazepines are best avoided due to the risks of the development of tolerance and physical dependence. The World Federation of Societies of Biological Psychiatry, say that benzodiazepines should not be used as a first-line treatment option but are an option for treatment-resistant cases of panic disorder. Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety as recommended best practice, benzodiazepines have remained a commonly used medication for panic disorder. They reported that in their view there is insufficient evidence to recommend one treatment over another for panic disorder. The APA noted that while benzodiazepines have the advantage of a rapid onset of action, that this is offset by the risk of developing a benzodiazepine dependence. The National Institute of Clinical Excellence came to a different conclusion, they pointed out the problems of using uncontrolled clinical trials to assess the effectiveness of pharmacotherapy and based on placebo-controlled research they concluded that benzodiazepines were not effective in the long-term for panic disorder and recommended that benzodiazepines not be used for longer than 4 weeks for panic disorder. Instead NICE clinical guidelines recommend alternative pharmacotherapeutic or psychotherapeutic interventions.
Interoceptive exposure is sometimes used for panic disorder. People's interoceptive triggers of anxiety are evaluated one-by-one before conducting interoceptive exposures, such as addressing palpation sensitivity via light exercise. Though this practice is used in 12-20% of cases.
Most research indicates that cognitive behavioral therapy (CBT) is an effective treatment for hypochondriasis. Much of this research is limited by methodological issues. A small amount of evidence suggests that selective serotonin reuptake inhibitors can also reduce symptoms, but further research is needed.
Approximately 1 to 5% of school-aged children have school refusal, though it is most common in 5- and 6-year olds and in 10- and 11-year olds, it occurs more frequently during major changes in a child’s life, such as entrance to kindergarten, changing from elementary to middle school, or changing from middle to high school. The problem may start following vacations, school holidays, summer vacation, or brief illness, after the child has been home for some time, and usually ends prior to vacations, school holidays, or summer vacation, before the child will be out of school for some time. School refusal can also occur after a stressful event, such as moving to a new house, or the death of a pet or relative.
The rate is similar within both genders, and although it is significantly more prevalent in some urban areas, there are no known socioeconomic differences.
Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. Benzodiazepines, monoamine oxidase inhibitor, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia. Antidepressants are important because some have antipanic effects. Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy. A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.
Benzodiazepines, antianxiety medications such as alprazolam and clonazepam, are used to treat anxiety and can also help control the symptoms of a panic attack. If taken in doses larger than those prescribed, or for too long, they can cause dependence. Side effects may include confusion, drowsiness, light-headedness, loss of balance, and memory loss.
Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results. As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.
Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.
The following are two therapies normally used in treating specific phobia:
Cognitive behavioral therapy (CBT), a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior, is effective in treating specific phobias. Exposure therapy is a particularly effective form of CBT for specific phobias. Medications to aid CBT have not been as encouraging with the exception of adjunctive D-clycoserine.
In general anxiolytic medication is not seen as helpful in specific phobia but benzodiazepines are sometimes used to help resolve acute episodes; as 2007 data were sparse for efficacy of any drug.
Factors that can cause reluctance to attend school can be divided into four categories. These categories have been developed based on studies in the United States under the leadership of Professor Christopher Kearney. Some students may be affected by several factors at once.
- The child might want to be free.
- The child possibly wants to avoid school-related issues and situations that cause them to experience unpleasant feelings, such as anxiety, depression, or psychosomatic symptoms. The reluctance to attend school is one symptom that can indicate the presence of a larger issue, such as anxiety disorder, depression, learning disability, sleep disorder, separation anxiety or panic disorder.
- The child may want to avoid tests, presentations, group work, specific lessons, or interaction with other children. The child should be assessed for learning disabilities if academic performance is average or low.
- The child may want attention from significant people outside of school, such as parents or older acquaintances.
- The child possibly wants to do something more enjoyable outside of school, like practice hobbies, play computer games, watch movies, play with friends such as riding bikes, etc., or learn autodidactictally.
Other factors can be:
- Anxiety about academic achievement and being tested can arise on the basis of inflated claims by teachers and/or parents, but also unrealistic ambitions of the upset child themselves.
- School refusal may arise as a response to bullying or peer rejection.
- Shyness or a social phobia can contribute to school refusal.
- The child might worry about parents or siblings, for instance, a parent with substance abuse, or a parent who physically abuses other family members.
- Some students may refuse to go to school due to anxiety or fears of emergency drills, such as fire, lockdown, and tornado drills.
Hypochondria is currently considered a psychosomatic disorder, as in a mental illness with physical symptoms. Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the Internet. The media and the Internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.
Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease.
Overly protective caregivers and an excessive focus on minor health concerns have been implicated as a potential cause of hypochondriasis development.
It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms.
Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families. Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder).
Specific phobias have a one-year prevalence of 8.7% in the USA with 21.9% of the cases being severe, 30.0% moderate and 48.1% mild. The usual age of onset is childhood to adolescence. Women are twice as likely to suffer from specific phobias as men.
Evolutionary psychology argues that infants or children develop specific phobias to things that could possibly harm them, so their phobias alert them to the danger.
The most common co-occurring disorder for children with a specific phobia is another anxiety disorder. Although comorbidity is frequent for children with specific phobias, it tends to be lower than for other anxiety disorders.
Onset is typically between 7 and 9 years of age. Specific phobias can occur at any age but seem to peak between 10 and 13 years of age.
Though some fears are inborn, the majority are learned. Phobias develop through negative experiences and through observation. One way children begin to develop fears is by witnessing or hearing about dangers. Ollendick proposes while some phobias may originate from a single traumatizing experience, others may be caused by simpler, or less dramatic, origins such as observing another child’s phobic reaction or through the exposure to media that introduces phobias.
- 2% of parents linked their child’s phobia to a [direct conditioning episode]
- 26% of parents linked their child’s phobia to a [vicarious conditioning episodes]
- 56% of parents linked their child’s phobia to their child’s very first contact with water
- 16% of parents could not directly link their child’s phobia
In addition to asking about the origins of a child’s fear, the questionnaire asked if parents believed that “information associated with adverse consequences was the most influential factor in the development of their child’s phobia.” The results were as followed:
- 0% of parents though it was the most influential factor
- 14% of parents though it was somewhat influential
- 86% of parents though it had little to no influence
According to Child and Adolescent Mental Health, approximately 5 percent of children suffer from specific phobias and 15 percent seek treatment for anxiety-related problems. In recent years the number of children with clinically diagnosed phobias has gradually increased. Researchers are finding that the majority of these diagnoses come anxiety related phobias or society phobias.
Specific phobias are more prevalent in girls than in boys. Likewise, specific phobias are also more prevalent in older children than younger.
The most common methods for the treatment of specific phobias are systematic desensitization and in vivo or exposure therapy.
The recommended treatment for adjustment disorder is psychotherapy. The goal of psychotherapy is symptom relief and behavior change. Anxiety may be presented as "a signal from the body" that something in the patient's life needs to change. Treatment allows the patient to put his or her distress or rage into words rather than into destructive actions. Individual therapy can help a person gain the support they need, identify abnormal responses and maximize the use of the individual's strengths. Counseling, psychotherapy, crisis intervention, family therapy, behavioral therapy and self-help group treatment are often used to encourage the verbalization of fears, anxiety, rage, helplessness, and hopelessness. Sometimes small doses of antidepressants and anxiolytics are used in addition to other forms of treatment. In patients with severe life stresses and a significant anxious component, benzodiazepines are used, although non-addictive alternatives have been recommended for patients with current or past heavy alcohol use, because of the greater risk of dependence. Tianeptine, alprazolam, and mianserin were found to be equally effective in patients with AD with anxiety. Additionally, antidepressants, antipsychotics (rarely) and stimulants (for individuals who became extremely withdrawn) have been used in treatment plans.
There has been little systematic research regarding the best way to manage individuals with an adjustment disorder. Because natural recovery is the norm, it has been argued that there is no need to intervene unless levels of risk or distress are high. However, for some individuals treatment may be beneficial. AD sufferers with depressive and/or anxiety symptoms may benefit from treatments usually used for depressive and/or anxiety disorders. One study found that AD sufferers received similar interventions to those with other psychiatric diagnoses, including psychological therapy and medication. Another study found that AD responded better than major depression to antidepressants. Given the absence of a meaningful evidence base for the treatment of AD "per se", watchful waiting should be considered initially; if symptoms are not improving or causing the sufferer marked distress then treatment should be directed at the predominating symptoms.
In addition to professional help, parents and caregivers can help their children with their difficulty adjusting by:
- offering encouragement to talk about his/her emotions
- offering support and understanding
- reassuring the child that their reactions are normal
- involving the child's teachers to check on their progress in school
- letting the child make simple decisions at home, such as what to eat for dinner or what show to watch on TV
- having the child engage in a hobby or activity they enjoy
The most widely used and possibly the most effective treatment for astraphobia is exposure to thunderstorms and eventually building an immunity. Cognitive behavioral therapy is also often used to treat astraphobia. The patient will in many cases be instructed to repeat phrases to himself or herself in order to become calm during a storm. Heavy breathing exercises can reinforce this effort.
Various factors have been found to be more associated with a diagnosis of AD than other axis I disorders, including:
- younger age
- more identified psychosocial and environmental problems
- increased suicidal behaviour, more likely to be rated as improved by the time of discharge from mental healthcare
- less frequent previous psychiatric history
- shorter length of treatment
Those exposed to repeated trauma are at greater risk, even if that trauma is in the distant past. Age can be a factor due to young children having fewer coping resources; children are also less likely to assess the consequences of a potential stressor.
A stressor is generally an event of a serious, unusual nature that an individual or group of individuals experience. The stressors that cause adjustment disorders may be grossly traumatic or relatively minor, like loss of a girlfriend/boyfriend, a poor report card, or moving to a new neighborhood. It is thought that the more chronic or recurrent the stressor, the more likely it is to produce a disorder. The objective nature of the stressor is of secondary importance. Stressors' most crucial link to their pathogenic potential is their perception by the patient as stressful. The presence of a causal stressor is essential before a diagnosis of adjustment disorder can be made.
There are certain stressors that are more common in different age groups:
Adulthood:
- Marital conflict
- Financial conflict
- Health issues with Oneself/Partner or Dependent children
- Personal tragedy (Death/personal loss)
- Loss of job or unstable employment conditions (e.g. Corporate takeover/redundancy)
Adolescence and childhood:
- Family conflict/parental separation
- School problems/changing schools
- Sexuality issues
- Death/illness/trauma in the family
In a study conducted from 1990 to 1994 on 89 psychiatric outpatient adolescents, 25% had attempted suicide in which 37.5% had misused alcohol, 87.5% displayed aggressive behaviour, 12.5% had learning difficulties, and 87.5% had anxiety symptoms.
Dogs may exhibit severe anxiety during thunderstorms; between 15 and 30 percent may be affected. Research confirms high levels of cortisol - a hormone associated with stress - affects dogs during and after thunderstorms. Remedies include behavioral therapies such as counter conditioning and desensitization, anti-anxiety medications, and Dog Appeasing Pheromone, a synthetic analogue of a hormone secreted by nursing canine mothers.
Studies have also shown that cats can be afraid of thunderstorms. Whilst it is very rare, cats have been known to hide under a table or behind a couch during a thunderstorm.
Generally if any animal is anxious during a thunderstorm or any similar, practically harmless event (e.g. fireworks display), it is advised to simply continue behaving normally, instead of attempting to comfort animals. Showing fearlessness is, arguably, the best method to "cure" the anxiety.
Some scholars believe that codependency is not a negative trait, and does not need to be treated, as it is more likely a healthy personality trait taken to excess. Codependency in nonclinical populations has some links with favourable characteristics of family functioning.
Stan Katz states that codependence is over-diagnosed, and that many people who could be helped with shorter-term treatments instead become dependent on long-term self-help programs. The language of, symptoms of, and treatment for codependence derive from the medical model suggesting a disease process underlies the behavior. However, there is no evidence that codependence is caused by a disease process.
In their book, “Attached.”, Dr. Amir Levine and Rachel S. F. Heller, address what they call the “codependency myth” by asserting that attachment theory is a more scientific and helpful model for understanding and dealing with attachment in adults.
Systematic desensitization therapy was introduced by Joseph Wolpe in 1958 and employs relaxation techniques with imagined situations. In a controlled environment, usually the therapist's office, the patient will be instructed to visualize a threatening situation (i.e., being in the same room with a dog). After determining the patient's anxiety level, the therapist then coaches the patient in breathing exercises and relaxation techniques to reduce their anxiety to a normal level. The therapy continues until the imagined situation no longer provokes an anxious response.
This method was use in the above-mentioned study done by Drs. Hoffmann and Human whereby twelve female students at the Arcadia campus of Technikon Pretoria College in South Africa were found to possess symptoms of cynophobia. These twelve students were provided with systematic desensitization therapy one hour per week for five to seven weeks; after eight months, the students were contacted again to evaluate the effectiveness of the therapy. Final results indicated the study was fairly successful with 75% of the participants showing significant improvement eight months after the study.
However, in his book, "Virtual Reality Therapy for Anxiety Disorders", Dr. Wiederhold questions the effectiveness of systematic desensitization as the intensity of the perceived threat is reliant on the patient's imagination and could therefore produce a false response in regards to the patient's level of anxiety. His research into recent technological developments has made it possible to integrate virtual reality into systematic desensitization therapy in order to accurately recreate the threatening situation. At the time of publication, there had been no studies done to determine its effectiveness.