introduction about anxiety essay

• Introduction To Anxiety Disorders

Introduction to Anxiety Disorders

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But if you have an anxiety disorder, this normally helpful emotion can do just the opposite -- it can keep you from coping and can disrupt your daily life. There are several types of anxiety disorders, each with their own distinct features.

An anxiety disorder may make you feel anxious most of the time, without any apparent reason. Or the anxious feelings may be so uncomfortable that to avoid them you may stop some everyday activities. Or you may have occasional bouts of anxiety so intense they terrify and immobilize you.

Anxiety disorders are the most common of all the mental health disorders. Considered in the category of anxiety disorders are: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia, Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress Disorder, and Acute Stress Disorder. Anxiety disorders as a whole cost the United States between 42-46 billion dollars a year in direct and indirect healthcare costs, which is a third of the yearly total mental health bill of 148 billion dollars. In the United States, social phobia is the most common anxiety disorder with approximately 5.3 million people per year suffering from it. Approximately 5.2 million people per year suffer from post-traumatic stress disorder. Estimates for panic disorder range between 3 to 6 million people per year, an anxiety disorder that twice as many women suffer from as men. Specific phobias affect more than 1 out of every 10 people with the prevalence for women being slightly higher than for men. Obsessive Compulsive disorder affects about every 2 to 3 people out of 100, with women and men being affected equally.

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Many people still carry the misperception that anxiety disorders are a character flaw, a problem that happens because you are weak. They say, "Pull yourself up by your own bootstraps!" and "You just have a case of the nerves." Wishing the symptoms away does not work -- but there are treatments that can help. Anxiety disorders and panic attacks are not signs of a character flaw. Most importantly, feeling anxious is not your fault. It is a serious mood disorder, which affects a person's ability to function in every day activities. It affects one's work, one's family, and one's social life.

Today, much more is known about the causes and treatment of this mental health problem. We know that there are biological and psychological components to every anxiety disorder and that the best form of treatment is a combination of cognitive-behavioral psychotherapy interventions. Depending upon the severity of the anxiety, medication is used in combination with psychotherapy. Contrary to the popular misconceptions about anxiety disorders today, it is not a purely biochemical or medical disorder.

There are as many potential causes of anxiety disorders as there are people who suffer from them. Family history and genetics play a part in the greater likelihood of someone getting an anxiety disorder in their lifetime. Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to anxiety. Anxiety symptoms can result from such a variety of factors including having had a traumatic experience, having to face major decisions in a one's life, or having developed a more fearful perspective on life. Anxiety caused by medications or substance or alcohol abuse is not typically recognized as an anxiety disorder.

We have developed the information here to act as a comprehensive guide to help you better understand anxiety disorders and find out more information about them on your own. Choose from among the categories at left to begin your journey into recovery from this treatable disorder.

Additional Resources

As advocates of mental health and wellness, we take great pride in educating our readers on the various online therapy providers available. MentalHelp has partnered with several thought leaders in the mental health and wellness space, so we can help you make informed decisions on your wellness journey. MentalHelp may receive marketing compensation from these companies should you choose to use their services.

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• The Development and Maintenance of Anxiety Disorders
• The Maintenance of Anxiety Disorders: Maladaptive Coping Strategies
• The new DSM-5: Anxiety Disorders and Obsessive-Compulsive Disorders
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• Treatment for Separation Anxiety Disorder
• Treatment for Specific Phobias and Treatment for Social Anxiety Disorder (Social Phobia)
• Treatment of Generalized Anxiety Disorder and Trauma
• Treatment of Panic-Related Anxiety Disorders
• What Panic Feels Like
• Oppositional Defiant Disorder
• Mens Health
• What Is Addiction?
• Signs, Symptoms, & Effects Of Addiction
• What Causes Addiction?
• Mental Health, Dual-Diagnosis, & Behavioral Addictions
• Addiction Treatment
• Addiction Recovery
• Information On Specific Drugs
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• Internet Addiction
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• ADHD: Attention Deficit Hyperactivity Disorder
• Anxiety Disorders
• Bipolar Disorder
• Depression: Major Depression & Unipolar Varieties
• Eating Disorders
• Childhood Mental Disorders And Illnesses
• Dissociative Disorders
• Impulse Control Disorders
• Internet Addiction And Media Issues
• Intellectual Disabilities
• Obsessive-Compulsive Spectrum Disorders
• Post-Traumatic Stress Disorder
• Schizophrenia
• Somatic Symptom And Related Disorders
• Tourettes And Other Tic Disorders
• Physical Mental Illness Flipbook
• Suicide Rates Vector Map
• Alzheimers Disease And Other Cognitive Disorders
• Chronic Obstructive Pulmonary Disease
• Colds And Flu
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• Family And Relationship Issues
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Learning Objectives

Upon completion of this module, participants will be able to:

• Define the concept anxiety
• Differentiate between stress, anxiety, and fear
• Identify and describe the different types of anxiety disorders
• Identify and explain the etiology of anxiety disorders

Introduction

Anxiety is a complex, yet normal, emotional response. It is when a person experiences chronic and excessive distress and/or worry regarding everyday life/situations, above a normal protective anxiety threshold, that it can be problematic. That is, the symptoms of anxiety are no longer temporary, protective, or transient. These symptoms can become debilitating thus impacting the ability to function day to day. For example, a person may not be able to function at work if they are consumed with worrying thoughts about their job performance. This worry can cause a person to engage in avoidance behavior (i.e., excessively calling in sick to work) or maladaptive coping (i.e., substance use). A person struggling with an anxiety disorder may experience a range of symptoms including physiological (i.e., rapid heart rate, increased sweating, shortness of breath, difficulty sleeping), behavioral (i.e., avoidance, use of illicit substances, fidgety), and cognitive (i.e., sense of impending doom, worry, thoughts of not being able to cope) (Hendel, 2021). This module will introduce readers to the conceptualization of anxiety, general prevalence and incidence rates related to anxiety and treatment, classification of anxiety disorders, and the etiology and risk factors associated with anxiety.

Conceptualizing Anxiety

Anxiety is a term that is often tossed around without people really knowing what it entails or means. I am sure you have heard a friend, partner, colleague, or perhaps yourself say, “I struggle with anxiety” OR “I am such an anxious person” OR “I am such a worry wart.” When people make such statements, what do they really mean? Are they aware that some anxiety is normal and adaptive? Have they been professionally diagnosed? Self-diagnosed? Are they aware there are different types of anxiety disorders such as agoraphobia? Are they confusing fear with anxiety? As a mental health provider, you may be required to assess and determine if an anxiety disorder exists and if so, which one(s).  Don’t fret, we will explore the various types of anxiety disorders later in this module.

There are numerous definitions of anxiety and among these definitions there is slight variation. Before reading the next statement, how would you define anxiety? For our purposes, we will use the definition provided by the American Psychological Association (APA). According to the APA (2022), “ anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat. ”

As we explore anxiety, you may be wondering what the difference is between anxiety, stress, and fear. While there is a bit of an overlap with these emotional responses, they have some differing characteristics. First, stress is usually set off by an external trigger (i.e., a deadline for a school or work project) (APA, 2022). Once the external trigger is resolved, the symptoms of stress tend to diminish. However, chronic stress can lead to symptoms of anxiety and in some cases, it can lead to disordered anxiety. This type of chronic stress and anxiety can trigger what we call a stress response.  Once the stress response is activated, specific parts of the brain are instructed to release certain hormones for the purpose of protection (i.e., cortisol, adrenaline). Second, anxiety is usually set off by an internal trigger which can include physical sensations, stress/fear response or thoughts (known as cognitions). Symptoms may include shortness of breath, worry, panic, and/or apprehension. These negative emotions and symptoms often stick around even in the absence of the trigger (Heshmet, 2018). Third, fear occurs when there is a real or perceived imminent threat. Fear is known to be present oriented. In contrast, a person who experiences anxiety as an emotional response is responding to the anticipation of a future perceived and/or uncertain threat (Heshmet, 2018). For example, a person with anxiety may experience excessive worry or dread about an upcoming college exam or an upcoming medical procedure. Anxiety is future oriented (i.e., anticipation, worry). According to the American Psychiatric Association (2013, p. 189), “these two states overlap, but they also differ. Fear is more often associated with surges of arousal necessary for fight/flight/freeze responses, thoughts of immediate danger, and escape behaviors, and anxiety is more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors.” Here is another example to illustrate the difference between fear and anxiety. You are preparing for a camping trip and in anticipation, you begin to worry about encountering spiders and other bugs (anticipatory anxiety). Once you have arrived at your location, you begin to set-up your campsite. During that process, you encounter a spider on your backpack which triggers a stress/fear response. Your body automatically goes into protection mode (increased heart rate and alertness, pupils dilate etc.). For some, the body can calm once the trigger has been eliminated and for others, they struggle to calm the parts of the brain that facilitate a stress/fear response. In the end, both anxiety and fear responses go through the similar brain pathways that cause behavioral and physiological symptoms. Furthermore, they can both impact a person’s ability to function day to day.

Context of Anxiety

Now that you have a better conceptual understanding of anxiety, let’s put things into a larger context by looking at prevalence rates and other important data points. Many of the statistics below use anxiety as an umbrella term. According to Anxiety and Depression Association of America (2018),

• Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.
• Approximately 7% of children aged 3-17 experience issues with anxiety each year. Most people develop symptoms before age 21.
• Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment.
• People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.

Answer the following questions based on the links below:

• What percentage of adults will experience anxiety in their lifetime?
• Do males or females have a higher prevalence of anxiety disorders?
• Which anxiety disorder has the highest prevalence overall?
• In the United States, what is the prevalence of social anxiety for African Americans? White Americans? Asian Americans, Hispanic Americans?

Click the following links to explore additional statistics by race, age, and gender.

https://www.singlecare.com/blog/news/anxiety-statistics/

https://www.therecoveryvillage.com/mental-health/anxiety/related/anxiety-disorder-statistics/

Anxiety Disorder Classification

It is often assumed that anxiety is one specific disorder when in fact, there are several types. As indicated earlier, anxiety disorders are an umbrella term which includes generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobia, and agoraphobia (historically, OCD and PTSD were captured as anxiety disorders but have since been placed within their own chapters in the DSM 5 classification system). These disorders can be differentiated from one another by the type of object and/or situations that produce a fear/stress response, avoidance behaviors and length of time symptoms have been present. Beyond the listed anxiety disorders below, it is also important to consider anxiety that is induced by the misuse of substance (licit and/or illicit substances). Furthermore, consider anxiety symptoms as the result of substance withdrawal (Mayo clinic, 2018).

Table 1: Common Anxiety Disorders and Associated Characteristics

(Mayo Clinic (2021); NAMI (2022)

Note: Although selective mutism and separation anxiety are considered anxiety disorders, they are not included in this series of modules. Historically, obsessive compulsive disorder and PTSD were categorized as anxiety disorders, but that is no longer the case as anxiety is not considered a defining feature. However, OCD is often treated with cognitive behavior therapy which is why it is added to the table.

While on the topic of anxiety disorders, I want to highlight another concept you may have encountered. That is the concept of functional anxiety . It is typically used in contrast to generalized anxiety disorder. While those with generalized anxiety tend to appear externally anxious and can struggle with day to day functioning, those with functional anxiety may present as calm, organized, confident, and outgoing. However, they are internally anxious and are able to function day to day by hiding or masking their anxiety (Cleveland Clinic, 2022).

PANS and PANDAS

When assessing children for a possible anxiety disorder, it is important to screen for one of two possible conditions: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS).  Both conditions have an acute onset and symptoms appear out of the blue. Symptoms often reflect the diagnostic criteria for obsessive-compulsive disorder. Other symptoms include changes in personality, tics, and restrictive eating (Child Mind Institute, n.d.). Acute onset of OCD like symptoms are an indicator to screen for PANS and PANDAS. While the cause is unclear, there has been a correlation between children who have recently had an infection, such as strep and PANS/PANDAS (PANDAS Network, 2022).

Click the link below for additional information on PANS and PANDAS.

https://childmind.org/guide/parents-guide-to-pans-and-pandas/#block_8a5183dd-a8e7-482d-8f56-e2274e5e521f

Challenge question: Now that you have a general sense of the common anxiety disorders, which do you believe is the most prevalent? Before jumping into a search engine to find the answer, try to answer on your own. Try ranking them from most to least prevalent.

Click the link below to find the answer to this challenge question.

Click the video link below for additional information on the definition of anxiety and the various types of anxiety.

https://www.youtube.com/watch?v=oSeJQVOLXPU

Etiology and Risk Factors of Anxiety

Assessing and diagnosing mental health conditions can be a complex process. During this process, one question clinicians often get is “what causes anxiety?” Although pinpointing the exact cause(s) is not always possible, providing psychoeducation can provide some insight and comfort. More importantly, although there is usually more than one cause and/or risk factor, research supported treatments are available to support those with an anxiety disorder. While knowing the exact cause may provide some relief for those struggling with anxiety, the underlying cause is not necessarily required for treatment. That said, it is always important to engage in the process of differential diagnosis in order to rule out possible substance use, medical conditions, or cultural elements that may be contributing factors. There are two overarching areas that are known causes (or etiology) of anxiety disorders; biological and sociocultural/environmental (NAMI, 2022).

Genetics: Research has shown that anxiety, as well as other mental health conditions that run within families increases one’s risk of developing the disorder (NAMI, 2022). Research indicates that a combination of genetics and exposure to a stressful environment account for greater risk than genetics alone.

Medical: When conducting an assessment, mental health providers should always engage in the process of differential diagnosis. There are several medical conditions that may contribute to someone experiencing symptoms of anxiety. For example, the following conditions are known to be associated with symptoms of anxiety; diabetes, hypoglycemia, medication use/misuse, thyroid issues (i.e., hyperthyroidism), and respiratory issues (i.e., asthma or COPD) (NAMI, 2022).

Neurobiology: Learning brain anatomy and physiology will not only help the mental health provider understand anxiety from a neurobiological viewpoint, but it will also help the consumer (i.e., psychoeducation). It can help make sense of the phenomenon that the client is experiencing such as learning about the two brain pathways that lead to anxiety. Understanding the neurobiology also assists in the treatment and recovery process.

The nervous system, which has two primary branches (central and peripheral nervous systems) plays a role in mental health disorders. For example, the parts of the brain that play a critical role in anxiety include the amygdala, thalamus, hypothalamus, and cortex (pre-frontal cortex) (Bridley & Daffin, 2018). Furthermore, there are specific chemicals within the brain and body that have an influence on anxiety and one’s response to anxiety, fear, and stress (known as neurotransmitters and hormones). You may be familiar with some of these chemicals which include serotonin, adrenaline, and cortisol.

At the most basic level, the building blocks of anxiety involve the central and peripheral nervous systems. To fully appreciate the complexity and nature of the fear/stress response and anxiety, it is important to take a deeper look into these systems. We know that anxiety impacts the brain in numerous ways including flooding the brain with chemicals including the stress hormone cortisol and adrenaline, increases hyperactivity in various parts of brain (amygdala), impacts your ability to thinking rationally/logically, and anxiety can train your brain to hold onto negative memories (conditioning).

Interestingly, decades of research have shown that the brain is very malleable.  That is, the brain can change and/or modify various structures and functions, even beyond the developmental age of 25. This process of change and modification is known as neuroplasticity .

** NOTE: Please note that while this is a brief overview of neurobiology, we will go into more depth regarding the anatomy and physiology of the brain in modules 2.

Sociocultural/Environmental

In reference to sociocultural factors, we are referring to things such as, but not limited to, socioeconomic status, immigration status, gender identity, sexual orientation, race, ethnicity, religious affiliation etc. It can be helpful to view these factors from an ecological perspective. That is, the reciprocal interaction between the person and their environment. Often a poor fit can lead to stress, fear, and anxiety and in many cases this experience can be chronic in nature. It is also important to consider the impact of the social determinants of health which can have an impact on a person’s overall health and well-being. Such determinants include access to quality healthcare, education, economic stability, and one’s community (i.e., neighborhood) (Bridley & Daffin, 2018).

Other Potential Causes

While biological and sociocultural factors are the most common causes of anxiety disorders, there are other factors to take into consideration. Other known anxiety contributors include, substance use (licit or illicit), personality and temperament, childhood abuse/neglect, chronic stress, and cognitive styles.

This chapter provided readers with an introduction and overview of the anxiety disorders. An important element addressed in this chapter was addressing the difference between stress, anxiety, and fear. Several areas associated with anxiety disorders, including the etiology and common characteristics were covered as they play a critical role in assessment, diagnosis, and intervention. Understanding anxiety disorders from both a medical, biological, and sociological/sociocultural perspective are critical for a more balanced and holistic perspective.

Learning Activities and Questions

• ______________ is known as the fear of fear disorder.
• Given what you have learned about anxiety disorders, which one is the most prevalent in the United States?
• Anxiety disorders is an umbrella term that captures several disorders. Identify two disorders and briefly describe how they are characterized.
• In your own words, briefly describe the differences and similarities between anxiety, fear, and stress.
• How would you describe PANS and PANDAS to a parent whose child is being considered for one of these conditions as part of the differential diagnosis process?
• For this scenario, video record your response. Scenario: One of your client’s whom you diagnosed as having generalized anxiety disorder is curious how they developed such a disorder. Verbatim, how would you respond to your client’s curiosity/question about the etiology of anxiety disorders?

American Psychological Association (2022). Anxiety . https://www.apa.org/topics/anxiety

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders 5 (5th Ed.). Washington, DC, American Psychiatric Press.

American Psychological Association. (2022). What’s the difference between stress and anxiety? 

https://www.apa.org/topics/stress/anxiety-difference#:~:text=People%20under%20stress%20experience%20mental,the%20absence%20of%20a%20stressor.

Anxiety and Depression Association of America (2018). Did you know? https://adaa.org/understanding-anxiety/facts-statistics

Bridley, A., & Daffin, L. W., (2018 ). Essentials of Abnormal Psychology (1st ed).

https://opentext.wsu.edu/abnormalpsychology/chapter/4-6-anxiety-disorders-etiology/

Child Mind Institute (n.d.). Complete Guide to PANS and PANDAS. https://childmind.org/guide/parents-guide-to-pans-and-pandas/#block_8a5183dd-a8e7-482d-8f56-e2274e5e521f

Cleveland Clinic (May 16, 2022). Signs you have functional anxiety.

https://health.clevelandclinic.org/what-is-high-functioning anxiety/#:~:text=What%20is%20high%2Dfunctioning%20anxiety,You%20may%20overreact%20at%20times.

Hendel, H.J., (2021). Anxiety and Fear: What’s the difference? NAMI. https://www.nami.org/Blogs/NAMI-Blog/May-2021/Anxiety-And-Fear-What-s-The-Difference

Heshmat, S. (2018) . Anxiety vs. fear: What is the difference? Psychology Today.

https://www.psychologytoday.com/us/blog/science-choice/201812/anxiety-vs-fear

Mayo Clinic (2021). Anxiety disorders .

https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

National Alliance of Mental Illness [NAMI], (2022). Anxiety disorders. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders

PANDAS Network (2022). Understanding PANDAS and PANS. https://pandasnetwork.org/understanding-pandas/

All About Anxiety: An Introductory Guide to Neuroscience, Assessment, and Intervention Copyright © 2022 by Jeff Driskell is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Home — Essay Samples — Nursing & Health — Psychiatry & Mental Health — Anxiety

Essays About Anxiety

Anxiety essay topic examples, argumentative essays.

Argumentative essays on anxiety require you to take a stance on a specific aspect of anxiety and provide evidence to support your viewpoint. Consider these topic examples:

• 1. Argue for the importance of mental health education in schools, emphasizing the role it plays in reducing anxiety among students.
• 2. Debate whether the increased use of technology and social media contributes to rising levels of anxiety among young adults, considering the pros and cons of digital connectivity.

Example Introduction Paragraph for an Argumentative Anxiety Essay: Anxiety is a prevalent mental health concern that affects individuals of all ages. In this argumentative essay, we will explore the significance of introducing comprehensive mental health education in schools and its potential to alleviate anxiety among students.

Example Conclusion Paragraph for an Argumentative Anxiety Essay: In conclusion, the argument for incorporating mental health education in schools underscores the need to address anxiety and related issues at an early stage. As we advocate for change, we are reminded of the positive impact such initiatives can have on the well-being of future generations.

Compare and Contrast Essays

Compare and contrast essays on anxiety involve analyzing the similarities and differences between various aspects of anxiety, treatment approaches, or the impact of anxiety on different demographic groups. Consider these topics:

• 1. Compare and contrast the experiences and coping mechanisms of individuals with generalized anxiety disorder (GAD) and social anxiety disorder (SAD), highlighting their unique challenges and commonalities.
• 2. Analyze the differences and similarities in the prevalence and impact of anxiety among different age groups, such as adolescents and older adults, considering the contributing factors and treatment options.

Example Introduction Paragraph for a Compare and Contrast Anxiety Essay: Anxiety manifests in various forms, affecting individuals differently. In this compare and contrast essay, we will examine the experiences and coping strategies of individuals with generalized anxiety disorder (GAD) and social anxiety disorder (SAD), shedding light on the distinctions and shared aspects of their conditions.

Example Conclusion Paragraph for a Compare and Contrast Anxiety Essay: In conclusion, the comparison and contrast of GAD and SAD provide valuable insights into the diverse landscape of anxiety disorders. As we deepen our understanding, we can better tailor support and interventions for those grappling with these challenges.

Descriptive Essays

Descriptive essays on anxiety allow you to provide a detailed account of anxiety-related experiences, the impact of anxiety on daily life, or the portrayal of anxiety in literature and media. Here are some topic ideas:

• 1. Describe a personal experience of overcoming a major anxiety-related obstacle or fear, highlighting the emotions and strategies involved in the process.
• 2. Analyze the portrayal of anxiety and mental health in a specific novel, movie, or television series, discussing its accuracy and the messages it conveys to the audience.

Example Introduction Paragraph for a Descriptive Anxiety Essay: Anxiety can be a formidable adversary, but it is also a source of resilience and personal growth. In this descriptive essay, I will recount a deeply personal journey of overcoming a significant anxiety-related challenge, shedding light on the emotions and strategies that guided me along the way.

Example Conclusion Paragraph for a Descriptive Anxiety Essay: In conclusion, my personal narrative of conquering anxiety illustrates the transformative power of resilience and determination. As we share our stories, we inspire others to confront their fears and embrace the path to recovery.

Persuasive Essays

Persuasive essays on anxiety involve advocating for specific actions, policies, or changes related to anxiety awareness, treatment accessibility, or destigmatization. Consider these persuasive topics:

• 1. Persuade your audience of the importance of increasing mental health resources on college campuses, emphasizing the positive impact on students' well-being and academic performance.
• 2. Advocate for the destigmatization of anxiety and other mental health conditions in society, highlighting the role of media, education, and public discourse in reducing stereotypes and discrimination.

Example Introduction Paragraph for a Persuasive Anxiety Essay: Anxiety affects millions of individuals, yet stigma and limited resources often hinder access to necessary support. In this persuasive essay, I will make a compelling case for the expansion of mental health services on college campuses, emphasizing the benefits to students' overall well-being and academic success.

Example Conclusion Paragraph for a Persuasive Anxiety Essay: In conclusion, the persuasive argument for increased mental health resources on college campuses highlights the urgent need to prioritize students' mental well-being. As we advocate for these changes, we contribute to a more inclusive and supportive educational environment.

Narrative Essays

Narrative essays on anxiety allow you to share personal stories, experiences, or perspectives related to anxiety, your journey to understanding and managing it, or the impact of anxiety on your life. Explore these narrative essay topics:

• 1. Narrate a personal experience of a panic attack, describing the physical and emotional sensations, the circumstances, and the steps taken to cope and recover.
• 2. Share a story of your journey toward self-acceptance and resilience in the face of anxiety, emphasizing the strategies and support systems that have helped you navigate this mental health challenge.

Example Introduction Paragraph for a Narrative Anxiety Essay: Anxiety is a deeply personal experience that can profoundly impact one's life. In this narrative essay, I will take you through a vivid account of a panic attack I experienced, offering insights into the physical and emotional aspects of this anxiety-related event.

Example Conclusion Paragraph for a Narrative Anxiety Essay: In conclusion, the narrative of my panic attack experience underscores the importance of self-awareness and coping strategies in managing anxiety. As we share our stories, we foster understanding and support for those facing similar challenges.

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Cognitive behavioral theory application for anxiety disorder, the problem of social anxiety disorders of teenagers, anxiety disorder among children and ways to prevent it, research of social anxiety disorder: symptoms, causes, effects and treatments, what is generalized anxiety disorder (gad) and its treatment, anxiety, its development, effects, and treatments, how to overcome depression and anxiety, the importance of managing stress and anxiety in early age, potential causes of anxiety disorders, the problem of public speaking anxiety, the way teachers can help their students to overcome anxiety and depression, fear and anxiety in our lives and how to deal with it, the effectiveness of cognitive behavioural therapy (cbt) for treating individuals with depression and anxiety, reflection on how i fought my social anxiety with the help of family, the power of following your fear and anxiety, social anxiety disorder and its impacts on the lives of the americans, types and causes of social anxiety disorder, research of anxiety increasing in the united states, distress and demoralozation of nurses as a source of anxiety and job seniority.

Anxiety is a psychological and physiological response characterized by feelings of apprehension, fear, and unease. It is a natural human reaction to perceived threats or stressors, triggering a heightened state of arousal and activating the body's fight-or-flight response.

Excessive worrying: Individuals with anxiety often experience persistent and intrusive thoughts, excessive worrying, and an inability to control their anxious thoughts. Physical symptoms: Anxiety can manifest physically, leading to symptoms such as increased heart rate, rapid breathing, sweating, trembling, muscle tension, headaches, and gastrointestinal disturbances. Restlessness and irritability: Anxiety can cause a sense of restlessness and irritability, making it difficult for individuals to relax or concentrate on tasks. Sleep disruptions: Anxiety has the potential to interfere with sleep patterns, resulting in challenges when trying to initiate sleep, maintain it, or achieve a restorative sleep. Consequently, this can exacerbate feelings of fatigue and weariness. Avoidance behaviors: People with anxiety may engage in avoidance behaviors, such as avoiding certain situations or places that trigger their anxiety. This can restrict their daily activities and limit their quality of life.

Genetic predisposition: Research suggests that individuals with a family history of anxiety disorders may have a higher likelihood of developing anxiety themselves. Certain genetic variations and inherited traits can increase susceptibility to anxiety. Brain chemistry: Imbalances in neurotransmitters, such as serotonin, dopamine, and gamma-aminobutyric acid (GABA), are thought to play a role in anxiety disorders. These chemical imbalances can affect the regulation of mood, emotions, and stress responses. Environmental factors: Traumatic life events, such as abuse, loss, or significant life changes, can trigger or exacerbate anxiety. Chronic stress, work pressure, and relationship difficulties can also contribute to the development of anxiety. Personality traits: Certain personality traits, such as being prone to perfectionism, having a negative outlook, or being highly self-critical, may increase the risk of developing anxiety disorders. Medical conditions: Certain medical conditions, such as thyroid disorders, cardiovascular issues, and respiratory problems, can be associated with anxiety symptoms.

Generalized Anxiety Disorder (GAD): GAD is marked by excessive and uncontrollable worry about various aspects of life, including work, health, and everyday situations. Individuals with GAD often experience physical symptoms like restlessness, fatigue, muscle tension, and difficulty concentrating. Panic Disorder: Panic disorder involves recurrent and unexpected panic attacks, which are intense episodes of fear accompanied by physical symptoms like rapid heart rate, shortness of breath, chest pain, and dizziness. People with panic disorder often worry about future panic attacks and may develop agoraphobia, avoiding places or situations that they fear might trigger an attack. Social Anxiety Disorder (SAD): SAD is characterized by an intense fear of social situations and a persistent worry about being embarrassed, judged, or humiliated. People with SAD may experience extreme self-consciousness, avoidance of social interactions, and physical symptoms like blushing, trembling, or sweating. Specific Phobias: Common examples include phobias of heights, spiders, flying, or enclosed spaces. Exposure to the feared object or situation can trigger severe anxiety symptoms. Obsessive-Compulsive Disorder (OCD): OCD is characterized by intrusive and unwanted thoughts (obsessions) that lead to repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety. Common obsessions include fears of contamination, doubts, and a need for symmetry, while common compulsions include excessive cleaning, checking, and arranging.

The treatment of anxiety typically involves a multi-faceted approach aimed at addressing the individual's specific needs. One common form of treatment is psychotherapy, which involves talking with a trained therapist to explore the underlying causes of anxiety and develop coping strategies. Cognitive-behavioral therapy (CBT) is often employed to challenge negative thought patterns and behaviors associated with anxiety. In some cases, anti-anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, may be prescribed by a healthcare professional. These medications work to alleviate the intensity of anxiety symptoms and promote a sense of calm. Additionally, lifestyle modifications can play a significant role in anxiety management. Regular exercise, stress-reduction techniques like meditation or yoga, and maintaining a balanced diet can contribute to overall well-being and help alleviate anxiety symptoms.

1. Anxiety disorders are highly prevalent mental health conditions that affect a substantial number of individuals worldwide, impacting approximately 284 million people globally. 2. Research indicates that women have a higher likelihood of being diagnosed with anxiety disorders compared to men. Studies reveal that women are twice as likely to experience anxiety, with this gender difference emerging during adolescence and persisting into adulthood. 3. Anxiety disorders often coexist with other mental health issues. Extensive research has demonstrated a strong correlation between anxiety disorders and comorbidities such as depression, substance abuse, and eating disorders. These co-occurring conditions can significantly impact an individual's well-being and require comprehensive and integrated approaches to treatment.

Anxiety is an important topic to explore in an essay due to its widespread impact on individuals and society as a whole. Understanding and addressing anxiety is crucial for several reasons. Firstly, anxiety disorders are highly prevalent, affecting a significant portion of the population globally. This prevalence highlights the need for increased awareness, accurate information, and effective strategies for prevention and treatment. Secondly, anxiety can have profound effects on individuals' mental, emotional, and physical well-being. It can impair daily functioning, hinder relationships, and limit personal growth. By delving into this topic, one can examine the various factors contributing to anxiety, its symptoms, and the potential consequences on individuals' lives. Additionally, exploring anxiety can shed light on the complex interplay between biological, psychological, and social factors that contribute to its development and maintenance. This understanding can inform the development of targeted interventions and support systems for individuals experiencing anxiety.

1. Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327-335. 2. Kessler, R. C., et al. (2005). Lifetime prevalence and age-of-onset distributions of anxiety disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. 3. National Institute of Mental Health. (2018). Anxiety disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/ 4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 5. Craske, M. G., et al. (2017). Anxiety disorders. Nature Reviews Disease Primers, 3(1), 17024. 6. Hofmann, S. G., et al. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. 7. Roy-Byrne, P. P., et al. (2010). Treating generalized anxiety disorder with second-generation antidepressants: A systematic review and meta-analysis. Journal of Clinical Psychiatry, 71(3), 306-317. 8. Etkin, A., et al. (2015). A cognitive-emotional biomarker for predicting remission with antidepressant medications: A report from the iSPOT-D trial. JAMA Psychiatry, 72(1), 14-22. 9. Heimberg, R. G., et al. (2014). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 293(23), 2884-2893. 10. Hofmann, S. G., et al. (2013). Efficacy of cognitive behavioral therapy for social anxiety disorder: A meta-analysis. Psychological Medicine, 43(05), 897-910.

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1 Overview and Introduction to Anxiety Disorders

Martin M. Antony, Department of Psychology, Ryerson University.

Anita Federici, Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, Canada.

Murray B. Stein, Department of Psychiatry, San Diego State University, San Diego, CA

• Published: 18 September 2012
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This chapter provides an overview of the Oxford Handbook of Anxiety and Related Disorders , and an introduction to the nature and treatment of anxiety and related disorders. With 51 chapters, this handbook covers a wide range of topics related to anxiety disorders, including phenomenology, etiology, assessment, and treatment. Key features of panic attacks and of each of the major anxiety disorders (e.g., panic disorder and agoraphobia, social phobia, specific phobia, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder) are reviewed. Etiological factors such as genetics, biological processes, learning, information processing, cultural factors, and personality are considered. The chapter concludes with a review of effective treatments (e.g., pharmacotherapy, psychological interventions, and combined approaches).

Orientation to the Handbook

As the fields of psychology, psychiatry, and related disciplines evolve, it is important for researchers and clinicians to remain up-to-date with the latest empirical findings, theoretical perspectives, and trends that subsequently guide their practices. In the area of anxiety research, significant gains have been made in recent years with respect to our conceptualization of anxiety disorders and the development of evidence-based treatments. While traditional theories and approaches remain highly influential, health professionals are continually searching for strategies and interventions to enhance existing therapies.

The primary goal in developing this text was to create a comprehensive and up-to-date handbook that would detail the various research and clinical developments in the field of anxiety. From phenomenology and classification to treatment and comorbidity, the reader is provided with extensive descriptive information, empirical findings, areas of controversy, and suggested future directions.

The balance between breadth and depth and the integration of both traditional and contemporary theories will appeal to clinicians, researchers, educators, and students alike. Each topic was chosen to reflect clinical and theoretical approaches that currently inform our understanding of the development and treatment of anxiety disorders. Furthermore, in order to incorporate multiple approaches and perspectives, chapters were written by authors from a variety of academic disciplines and clinical backgrounds (e.g., psychology, psychiatry, nursing, social work).

The first part of the book includes this overview and introduction. Part Two provides a descriptive review of each of the main anxiety disorders: panic disorder, social phobia, and specific phobia (Chapter 3 ), generalized anxiety disorder (GAD) (Chapter 4 ), obsessive-compulsive disorder (OCD) (Chapter 5 ), and posttraumatic stress disorder (PTSD) (Chapter 6 ). In addition to a review of diagnostic criteria, prevalence rates, and comorbidity, each chapter highlights current conceptual, methodological, and clinical issues in the field. For example, suicide risk, health care utilization, and functional impairment across the anxiety disorders are discussed in Chapter 2 . Hazlett-Stevens, Pruitt, and Collins (Chapter 4 ) add clarity to the term worry in GAD by differentiating it from obsessive thoughts, depressive ruminations, and “normal” levels of worry in the general population. In her review of OCD, Mathews (Chapter 5 ) discusses the pros and cons of various subtyping approaches and highlights current diagnostic and conceptual issues between OCD and other comorbid conditions.

Part Three focuses on empirically supported neurobiological and psychological approaches to understanding anxiety disorders. Chapters 7 through 10 describe advances in animal research (Chapter 7 ), genetic research (Chapter 8 ), and neuoranatomical models (Chapter 9 ) that have contributed to our evolving understanding of the biological processes involved in decision making, detection of threat, and emotional responding. Chapters 11 through 19 offer detailed descriptions of the most influential psychological models in the field of anxiety. While some chapters provide details on well-established theoretical models (e.g., learning theories, cognitive behavioral models), other chapters present more contemporary and integrative theories (e.g., Barlow's “triple vulnerability” model in Chapter 13 ; emotional dysregulation and intolerance of uncertainty models of GAD in Chapter 17 ). This section is strengthened by the addition of several chapters that focus on developmental theories, early prevention (Chapter 11 ), the impact of family and social relationships (Chapter 14 ), and the role of personality (Chapter 15 ) in the development and maintenance of anxiety disorders.

Part Four presents current issues in classification and assessment. Establishing accurate diagnoses, determining predominant conditions, and ruling out additional disorders is a challenging and complex skill. Given that diagnoses have important implications for case conceptualization and treatment planning, a thorough and up-to-date understanding of issues that may complicate assessment (e.g., differential diagnoses, comorbidity) is essential. Lawrence and Brown (Chapter 20 ) address concerns regarding diagnostic overlap between syndromes and draw attention to the limitations of the primarily categorical approach adopted in the current edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM–IV–TR; American Psychiatric Association [APA], 2000). The following chapter on assessment strategies (Chapter 21 ) reviews the functions of assessment and provides a useful framework for selecting various empirically supported assessment measures.

Part Five represents the largest section of this book and focuses specifically on treatment approaches. For each of the major anxiety disorders, detailed discussions of both pharmacological and psychological approaches are provided. In addition to reviewing empirical data on traditional and well-recognized interventions, these chapters also highlight innovative and alternative treatment approaches. For example, chapters include information on the use of virtual reality (Chapter 25 ), transdiagnostic protocols (Chapter 33 ), the use of herbal products and complementary treatments (Chapter 34 ), acceptance and mindfulness-based approaches (Chapter 36 ), and self-help treatments (Chapter 37 ). In addition, unique issues such as treating nocturnal panic attacks (Chapter 22 ), eye movement desensitization reprocessing techniques in PTSD (Chapter 31 ), the use of surgical procedures to treat OCD (Chapter 28 ), prevention of anxiety in children (Chapter 38 ), and treating anxiety in primary care settings (Chapter 39 ) are also discussed in detail.

The attention to breadth and depth is also apparent in the next three sections of the book where in-depth information is provided about other anxiety-based conditions, (e.g., hypochondriasis, body dysmorphic disorder), special topics related to comorbid substance use, cultural issues, and the impact of anxiety disorders in specific populations (e.g., children, older adults). Additionally, the inclusion of such topics as the fear of pain (Chapter 42 ) and the relationship between anxiety and sleep (Chapter 47 ) further expand our scope of understanding. The final part of the book (Chapter 51 ) provides an overview of future directions in anxiety disorders research.

In the remainder to this introductory chapter, a brief introduction to the diagnostic features of the anxiety disorders will be provided, followed by a general summary of issues pertaining to etiology and treatment. The purpose of this section is to offer a concise review of the major themes, concepts, and approaches that will be discussed in subsequent chapters.

General Introduction to the Anxiety Disorders

The anxiety disorders are among the most common and debilitating of the psychological disorders. Often chronic in nature, anxiety disorders are associated with severe impairments across interpersonal and occupational domains. The purpose of this section is to provide a general introduction to the main anxiety disorders outlined in the DSM–IV–TR . Specific attention is given to diagnostic features, prevalence rates, comorbidity, and issues in assessment.

Panic Attacks

The DSM–IV–TR defines a panic attack as a period of intense fear or discomfort in which the individual experiences at least four of the following symptoms (peaking in intensity within 10 minutes or less): racing or pounding heart, sweating, trembling, shortness of breath, choking sensations, chest pain or tightness, nausea or stomach upset, dizziness, derealization or depersonalization, fear of losing control or going crazy, fear of dying, numbness or tingling sensations, and chills or hot flushes. The term limited symptom attack is used to describe an attack in which fewer than four symptoms are present. Panic attacks are not specific to any one anxiety disorder. For example, individuals with panic disorder, specific phobia, and social phobia may experience panic attacks during the course of their illness. In order to provide greater diagnostic and descriptive clarity, there are three main types of panic attacks. Unexpected or “uncued” attacks are those that occur in situations or places in which the individual normally feels safe. Often, people report that they occur “out of the blue” and are not associated with any specific trigger or cue. Situationally bound or “cued” attacks are those that occur almost always in response to a feared stimulus (e.g., a person with a specific phobia of driving experiences a panic attack when riding in a car). Situationally predisposed attacks are those that are more likely to occur in particular types of situations, but do not always occur (e.g., a person with panic disorder with agoraphobia who often has panic attacks in public places).

Panic Disorder

Diagnostic criteria for panic disorder require that an individual experience recurrent and unexpected panic attacks that are followed by a period of at least 1 month of marked worry about having additional attacks, anxiety about the implications of the attacks (e.g., having a heart attack, going crazy), and/ or a significant change in behavior. Although they frequently co-occur, panic disorder may or may not be associated with agoraphobia , or the intentional avoidance of situations/places from which it might be difficult to escape or receive help in the event of a panic attack (e.g., being away from home, crowds, public transportation, shopping malls). For individuals whose symptoms have never met full criteria for panic disorder but who endorse significant avoidance and fear of panic-like symptoms (e.g., diarrhea, dizziness), a diagnosis of agoraphobia without a history of panic disorder may be warranted. Lifetime prevalence rates of panic disorder (with or without agoraphobia) in the general population are estimated to be at about 4.5%, whereas agoraphobia without history of panic disorder has been found to occur in 1.4% of the population (Kessler, Berglund, Demler, Jin, & Walters, 2005 ). This condition is more common among women than men. Symptoms typically develop in late adolescence or early adulthood and tend to vary in frequency and intensity across the lifespan.

Social Phobia

The essential feature of social phobia (or social anxiety disorder) is marked fear and anxiety about being negatively evaluated in social or performance-based situations (e.g., public speaking, meeting strangers, maintaining conversations). Fearful of being judged, criticized, or embarrassed, individuals with social phobia often avoid social situations or endure them with considerable distress. For individuals whose fears are related to multiple situations (e.g., formal speaking, eating in front of others, dating situations, etc.), the diagnostic specifier generalized type may be added. Common in the general population (lifetime prevalence rates range from 7% to 13%) (Furmark, 2002 ;Ruscio et al., 2008 ), the disorder typically begins in early adolescence (APA, 2000). In addition, it is not uncommon for social phobia to be associated with substance use, bulimia nervosa, and to occur within the context of a mood disorder or other anxiety disorders. Currently, an area of debate and an issue of diagnostic specificity is the significant symptom overlap between social phobia on Axis I and avoidant personality disorder on Axis II (see Chapter 3 ).

Specific Phobia

The DSM–IV–TR describes specific phobia as clinically significant anxiety and disproportionate fear of specific objects or situations. The five main types of specific phobia in DSM–IV–TR include animal type (e.g., fear of snakes, spiders, dogs), natural environment type (e.g., fear of heights, storms, water), blood-injection-injury type (e.g., fear of blood, needles, surgery), situational type (e.g., fear of enclosed places, driving, flying), and other type (e.g., fear of vomiting, choking, or other specific objects or situations). Despite awareness that their fear is excessive, individuals with specific phobia typically avoid the feared object or situation. Although specific phobia is among the most commonly occurring anxiety disorders, with a recent lifetime prevalence estimate of 12.5% (Kessler et al., 2005 ), only a small proportion of sufferers (12% to 30%) are estimated to seek treatment for their symptoms (APA, 2000). Often, specific phobias are diagnosed as additional disorders in people suffering from other anxiety disorders or depression. In these cases, the other disorder is usually the prominent focus of attention. Among the anxiety disorders, specific phobias are the most responsive to treatment. As discussed in greater detail in Chapter 25 , significant improvements have been observed after a single session of exposure treatment. With regard to assessment, it is important for clinicians to be aware of diagnostic similarities between specific phobia and other psychological disorders such as hypochondriasis (fear of illness or disease), panic disorder (fear of physical sensations), and eating disorders (fear of food or weight gain).

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by persistent and intrusive obsessions and/or compulsive behaviors. Obsessions may take the form of thoughts, images, or impulses and often surround themes such as contamination, doubting, aggression, accidental harm, religion, or thoughts of a sexual nature. Unlike a delusional or psychotic disorder, individuals with OCD recognize that their obsessions are a product of their own mind (APA, 2000). Compulsions are ritualistic behaviors that an individual feels compelled to perform in order to reduce feelings of anxiety and discomfort brought on by the obsession. Compulsive behaviors may include repeated hand-washing, checking, counting, hoarding, or a need for symmetry. In order to meet diagnostic criteria for OCD, the obsessions and compulsions must either be time-consuming or cause clinically significant distress. Prevalence rates for OCD have been estimated to be approximately 1.6% in community samples (Kessler et al., 2005 ) and the disorder appears to be about equally distributed among males and females (APA, 2000). Accurate assessment of OCD is complicated by the need to differentiate obsessions from delusional beliefs, depressive ruminations in major depressive disorder, and excessive worries about real-world concerns in generalized anxiety disorder (see Chapter 4 ). A key area of current interest among researchers and clinicians is the relationship between OCD and disorders that have similar obsessive and compulsive traits. Sometimes referred to as the obsessive-compulsive spectrum disorders, some researchers hypothesize that conditions such as Tourette's syndrome, body dysmorphic disorder, trichotillomania, eating disorders, hypochondriasis, and obsessive-compulsive personality disorder may be etiologically similar to OCD.

Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) describes a set of characteristic somatic and cognitive symptoms, lasting at least 1 month, that occur in response to a highly traumatic event. As outlined in the DSM–IV–TR , the individual must experience or witness a traumatic event involving physical threat to the self or other (e.g., serious car accident, rape, combat). The criteria also specify that the person's response to the event must be one of intense fear, helplessness, or horror. In addition, individuals must demonstrate clinically significant and distressing symptoms from three distinct clusters: reexperiencing symptoms (e.g., recurrent nightmares, intrusive thoughts, flashbacks), increased arousal (e.g., irritability, hypervigilance), and avoidance/numbing symptoms (e.g., feelings of detachment, avoidance of people or places connected to the trauma). Posttraumatic stress disorder can be acute (〉 3 months duration), chronic (〈 3 months duration), or with delayed onset (symptoms develop 6 months after traumatic event). In the general population, PTSD has a lifetime prevalence rate of approximately 8% (APA, 2000); however, rates are significantly greater among victims of abuse, crime, and war. Chapter 6 provides a review of epidemiological data, risk factors, and prominent psychological models of PTSD.

Acute Stress Disorder

Introduced with the publication of DSM-IV (APA,1994), acute stress disorder (ASD) is a relatively new diagnostic entity. The term is used to describe the development following exposure to a traumatic event of time-limited symptoms that are similar to those in PTSD (e.g., reexperiencing, avoidant, and arousal symptoms). However, ASD differs from PTSD in that it must occur within 1 month of the traumatic event and may not last longer than 4 consecutive weeks (beyond which a diagnosis of PTSD might be made). In addition, there is greater emphasis on dissociative symptoms in ASD (e.g., depersonalization, numbing, derealization, dissociative amnesia). The exact prevalence of ASD is not presently known, although estimates ranging from 14% to 33% in the aftermath of traumatic events have been described in the literature (APA, 2000). For more information on ASD and other stress-based responses (e.g., complex PTSD, disorders of extreme stress), see Chapter 6 .

Generalized Anxiety Disorder

The hallmark of generalized anxiety disorder (GAD) is excessive and pervasive worry about a variety of topics such as minor matters (e.g., punctuality, small repairs), job security, finances, health of loved ones, future events. Worries in GAD are distinguished from nonpathological worry by their unrealistic and uncontrollable nature. In GAD, the worry is frequent (occurring more days than not) and chronic (lasting at least 6 months), though individuals with GAD often report that they have worried in this manner for the majority of their life. The criteria for GAD also require that individuals report at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and difficulty sleeping. Lifetime prevalence rates for GAD have been estimated to be 5.7% (Kessler et al., 2005 ), and GAD is more common among women than men (APA, 2000). Similar to the patterns observed in other anxiety disorders, individuals with GAD often have additional psychological disorders, the two most common being major depressive disorder and panic disorder (Campbell & Brown, 2002 ). More information about the features of GAD can be found in Chapter 4 . It is also notable that, as GAD has evolved diagnostically over the past two decades, pharmacological and psychological treatments for GAD have also advanced. A review of the empirical data and a discussion on more contemporary approaches to treatment are described in Chapters 26 and 27 .

Etiology of Anxiety Disorders

Most theorists agree that a single etiological cause in not sufficient to explain the developmental complexity and heterogeneity that characterize the anxiety disorders. Whereas early theoretical accounts tended to emphasize the independent and exclusive role of either nature (e.g., biology, including genetics) or nurture (e.g., learning, environment), contemporary theories of the development and maintenance of anxiety are based on more sophisticated, biopsychosocial models that include cognitive, behavioral, genetic, and environmental elements. Over the past 20 years, these multidimensional approaches have greatly enhanced the way clinicians understand and treat these disorders. The following section will provide a brief introduction to the predominate approaches that currently guide research and treatment protocols.

Biological Processes

A great many biological processes have been implicated in risk for anxiety disorders, as well as in expression of anxiety disorders. In the past decade, biochemical theories of anxiety—which, it should be noted, overlap substantially with biochemical theories of depression—have focused on neurotransmitter systems that use serotonin (5-HT) or corticotropin-releasing factor (CRF), though numerous other neurotransmitters and neurohormones have also been implicated (see Chapters 7 and 10 ). More recently, there has been some convergence of theory (and supporting evidence) that risk for many (though perhaps not all of the) anxiety disorders may overlap substantially with biological factors that influence anxiety-related personality traits (e.g., the confluence of high neurosis and low extraversion, sometimes referred to as “neurotic introversion”) (Bienvenu, Hettema, Neale, Prescott, & Kendler, 2007 ). What types of biological factors fit this mold?

There is evidence from animal studies that variation in the serotonin transporter promoter (5-HTTLPR) is relevant to our understanding of the relationship between personality and anxiety (and depressive) disorders. Mice with loss of serotonin transporter function due to genetic knockout have increased anxiety-like behaviors and exaggerated stress responses (Holmes, Murphy, & Crawley, 2003 ). In addition, Barr et al. 2004 assessed stress responsivity in infant rhesus macaques reared either with their mothers or in peer-only groups. At 6 months of age, adrenocorticotropic hormone (ACTH) responses and cortisol levels were measured at baseline and during a period of separation. Serotonin transporter genotype was also measured, and animals were characterized as either being homozygous for the long form of the serotonin transporter (“l/l”) or having one copy of the long form and one copy of the short form (“l/s”). It was found that ACTH and cortisol levels increased during separation, consistent with the stressful nature of this experience. There was also an interaction between rearing experience and 5-HTLLPR genotype such that l/s animals had higher ACTH levels during separation than did l/l animals. This study is an example in nonhuman primates of how early life experience and genetics may interact to yield alterations in stress responsiveness and, by inference, risk for anxiety and mood disorders. The observation—now oft-replicated—that human variation in this polymorphism (5-HTTLPR) is associated with risk for adverse mental health outcomes (e.g., depression) in the context of life stress has resulted in 5-HTTLPR becoming the gene celebre of anxiety and depression research. More important, however, it has taken discussion of biopsychosocial models from the realm of the philosophical to the level of systems neuroscience (Caspi & Moffitt, 2006 ), ushering in an era of testable theories about genes and environment and their interaction. Though much of this work to date has focused on gene-environment interactions relevant to understanding depression, evidence is accruing that these relationships may be equally—or more—important for understanding risk for anxiety and related disorders (Stein, Schork, & Gelernter, in press). The role of genetic factors in anxiety and related disorders is covered in Chapter 8 .

The notion of differential susceptibility to stress is certain to influence our thinking about the etiology of anxiety for years to come. In fact, measures of psychological resilience have been developed and validated (Campbell-Sills & Stein, in press; Connor & Davidson, 2003 ), and are likely to feature more prominently in research studies. Furthermore, the concept of resilience to stress is now being considered from a neuroscience perspective, yielding many candidate systems—above and beyond those involving serotonin—whose further study will undoubtedly help us ascertain individual differences that determine how the human psyche can so often thrive in the face of great adversity (Charney, 2004 ).

Brain imaging has provided another window into the biology of anxiety and related disorders, and is the focus of Chapter 9 . Having evolved from studies of symptom provocation to the use of various types of emotion-processing tasks (e.g., the viewing of emotional faces), investigators have identified neural circuits that seem to function differently in patients with anxiety disorders. Two brain regions that have been consistently observed in patients with anxiety disorders to exhibit increased responsiveness in these types of paradigms are the amygdala and insula (Etkin & Wager, 2007 ). Moreover, hyperactivity in these regions has also been seen in individuals with high levels of traits such as neuroticism or anxiety sensitivity that can be considered to characterize them as anxiety-prone (Stein, Simmons, Feinstein, & Paulus, 2007 ), therein extending the possibility that this represents a “core” biological feature of these disorders. Notably, however, not all anxiety disorders share all these functional neuroimaging features (e.g., OCD), and it is these differences that may ultimately support the kind of biologically based classification system discussed earlier in this chapter.

Psychological Processes

Psychological theories of anxiety have predominately focused on the role of cognitive processes and behavioral responses to describe the acquisition and maintenance of anxiety disorders. Behavioral models include both classical and operant conditioning theories, highlighting the role of learning and the reinforcing nature of maladaptive responses to objects or situations. Classical conditioning models posit that fear and phobias develop as a result of the pairing between a neutral stimulus (e.g., dog) and an aversive experience (e.g., being bitten by a dog). While this model offered insight into the etiology of anxiety disorders, it did not account for the persistence and generalization of the fear response (e.g., fearing all dogs). To address this shortcoming, Mowrer 1960 proposed a two-factor theory of fear acquisition. Drawing from the pioneering work of Pavlov, Watson, and Skinner, he theorized that fears were established through principles of classical conditioning and maintained as a function of operant conditioning. In other words, while the avoidant and escape behaviors commonly observed among anxiety sufferers reduce distress and suffering in the short-term, they ultimately perpetuate anxiety in the long-term through negative reinforcement. In this way, the natural course of extinction is prevented and the fear is maintained. Several chapters include information on the influence of traditional and present-day learning theories among the anxiety disorders including posttraumatic stress disorder (Chapter 19 ), panic and phobias (Chapter 16 ), and generalized anxiety disorder (Chapter 17 ).

While conditioning models were highly influential, several important limitations were identified. For instance, they are unable to explain why some people develop phobias and others do not, after exposure to the same aversive or distressing stimulus. They also fail to explain how some individuals develop anxiety disorders in the absence of a personally aversive experience (e.g., developing a fear of flying, without having ever been on a plane). It was also unclear why certain stimuli (e.g., snakes, spiders, heights) were more likely to establish a fear response than others (e.g., electrical outlets, guns). The criticisms concerning the behavioral theories prompted clinicians and researchers to develop more sophisticated and inclusive models to explain anxiety, and to acknowledge the importance of observational learning, learning through the verbal transmission of information, emotional processing, and biological constraints on learning (e.g., Craske, Hermans & Vansteenwegen, 2006 ; Otto, 2002 ; Rachman, 1976 ; Rothbaum, 2006 ).

Some of the most influential work to emerge in the field of anxiety disorders was based on cognitive theories and approaches. Beck's (1976) cognitive theory of anxiety and depression was particularly important in providing a conceptual framework for anxiety. He proposed that emotions were largely determined by dysfunctional thoughts, beliefs, and attitudes. For example, a person with social phobia may believe that he or she will be ridiculed and rejected by others and consequently begins to experience anxiety and fear. In turn, these beliefs lead to avoidant behaviors, which, as previously noted, serve to maintain fear by prohibiting the individual from learning how to successfully cope with an anxiety-provoking situation. In addition, research has shown that maladaptive thoughts and beliefs significantly impact other cognitive domains such as memory, attention, and information processing. For instance, individuals with anxiety disorders are more likely to selectively recall and attend to fear-congruent objects or situations in their environments, and to process ambiguous stimuli as threatening (Mathews & MacLeod, 1994 ). McNally and Reese (Chapter 12 ) provide a comprehensive review of this area.

The specific meanings that people attach to their thoughts and experiences have also received increased attention in recent years. David Clark's 1986 influential theory proposed that one of the key variables that determined the maintenance of panic disorder was the misinterpretation of physical sensations (see Chapter 16 ). For example, a person with panic disorder may sense uncomfortable physical sensations during a panic attack (e.g., increased heart rate, shaking) and interpret these sensations as a sign of impending danger (“I'm having a heart attack”; “I will die or lose control if this continues”). Also drawing from the cognitive theories, Paul Salkovskis (2002) has emphasized the role of beliefs about personal responsibility and a sense of inflated importance that individuals with OCD attribute to their obsessional thoughts (see Chapter 18 ). Concepts such as thought-action fusion (e.g., believing that having a thought increases the likelihood of a particular outcome) and the tendency for individuals with OCD to believe that their intrusive and disturbing thoughts are a reflection of their underlying moral character are additional examples of how beliefs and perceptions shape and maintain anxiety (see Chapter 18 ).

Developmental Processes

Developmental theories that contribute to current understandings of the anxiety disorders emphasize the role of childhood temperament, parenting styles, family relationships, and aversive experiences in early childhood. As outlined by Hudson and Rapee (Chapter 14 ), one area that has received much attention is the impact of parenting styles on the development and maintenance of anxiety. Research has fairly consistently demonstrated a strong relationship between the development of an anxiety disorder and parents who are described as controlling, and overprotective. Furthermore, anxiety disorders are more common among o spring of parents who support avoidant behaviors and who fail to adequately encourage independence in their children. Though more research is needed, there may be a relationship between anxiety disorders and parents who exhibit greater levels of rejection and indifference toward their children. With regard to the broader family in general, the degree of cohesion, warmth, and support between parents, children, and among siblings appears to increase risk for developing an anxiety disorder. The consequences of these factors on parent-child attachment are discussed in greater detail in Chapter 14 .

In addition to these findings, it is also widely acknowledged that childhood temperament likely plays a significant role in the parent-child relationship. For instance, children who are shy, inhibited, anxious, or depressed may elicit overprotective behaviors in parents. Researchers have suggested that such parenting styles tend to increase a child's overall vulnerability to anxiety disorders by decreasing self-confidence, self-efficacy, and autonomy. Childhood temperament has also been associated with the development of specific anxiety disorders. In Chapter 11 , Poulton, Grisham, and Andrews review research demonstrating a relationship between childhood hyperactivity, antisocial behavior, trauma exposure, and the subsequent development of PTSD. These data suggest that difficulties with emotion regulation in childhood may increase vulnerability to posttraumatic stress reactions as the individual may not be able to adequately process, integrate, and psychologically cope with aversive or traumatic experiences over his or her lifetime. Other types of aversive childhood experiences that tend to increase the risk of developing anxiety disorders include marital conflict and divorce, death of a parent, sexual abuse, mental health problems within the immediate family, and other psychosocial stressors such as financial strain and low socioeconomic status (for more information on these topics, see Chapters 11 , 14 , and 49 ).

Other prominent areas of study within the developmental framework include the evaluation of parental and extrafamilial modeling and the role of social and peer relationships. With regard to the former, there is some evidence to suggest that anxiety-related information may be transmitted to children through the behaviors and beliefs of their parents or from individuals in their social environments (see Chapter 14 ). For example, anxious parents may directly or indirectly communicate and reinforce avoidant behaviors in their children as a result of their own fears and phobias. In terms of social relationships, researchers are beginning to focus more attention on the role of peer victimization, social acceptance, and the quality of friendships as important variables in both the development and maintenance of anxiety disorders. Hudson and Rapee (Chapter 14 ) discuss the impact of social rejection, teasing, and bullying on anxiety and also provide information on including family members in treatment.

Cultural Influences

Researchers from a variety of clinical, theoretical, and international backgrounds have begun to explore the way in which cultural variables influence the development and expression of anxiety disorders. To date, the majority of research in this area has focused on differences in the presentation and prevalence rates of pathological anxiety between Eastern and Western societies. These data demonstrate that the anxiety disorders appear to be represented relatively consistently across cultures, although their manifestations may be markedly different. For example, obsessional thoughts in individuals with OCD tend to be culturally relevant (e.g., thoughts of witchcraft versus thoughts of sexually abusing a child). Asmal and Stein (Chapter 50 ) discuss how anxiety disorders vary across cultures and discuss similarities between various “culture-bound” syndromes. Though research in this area is still in its infancy, investigators hypothesize that the religious beliefs, norms, gender expectations, and illness perceptions of the dominant culture greatly shape the presentation of the anxiety disorders. Hudson and Rapee (Chapter 14 ) also describe briefly how specific cultural beliefs may shape reported prevalence rates.

Personality Traits and Disorders

One of the ways researchers have attempted to differentiate and further understand the anxiety disorders has been to evaluate the presence of specific personality traits among sufferers. The most consistent finding to date is that neuroticism occurs frequently across anxiety disorders. Other factors, however, have emerged that have become differentially associated with specific anxiety presentations. Pagura, Cox, and Enns (Chapter 15 ) discuss the unique relationships between anxiety sensitivity and panic disorder, perfectionism and OCD, antisocial behaviors and PTSD, and shyness/self-criticism in social phobia.

With regard to specific Axis II comorbidity, cluster C disorders (anxious/avoidant type) are most common among individuals with anxiety disorders. Rates of avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder are particularly high among patients with social phobia, panic disorder, and OCD, respectively. The co-occurrence of these disorders presents unique challenges in the domains of assessment and treatment. As reviewed by Brandes and Bienvenu (Chapter 45 ), comorbid personality and anxiety disorders are associated with a more protracted clinical course, greater impairment and distress, increased suicidal ideation or attempts, and an overall poor response to treatment. A current area of debate involves the significant overlap between the diagnostic criteria for social phobia and avoidant personality disorder. Sharing many key features, some argue that the two disorders essentially capture the same construct at varying levels of intensity and functional impairment, with avoidant personality disorder corresponding to a more severe variant of social phobia. Further discussion regarding categorical versus dimensional classification approaches can be found in Chapter 20 .

While the precise nature of the relationship between personality and anxiety is unclear, competing theories have been proposed to explain how they might interact and influence one another. For example, some researchers argue that personality traits and temperament are inherent factors that place an individual at greater risk for the subsequent development of an anxiety disorder. Others contend that the presence of chronic anxiety precedes and shapes the expression of specific personality traits. Still others propose that the co-occurring disorders share a common underlying cause and are, therefore, etiologically related. Relevant empirical data for these theoretical models and related treatment implications are presented in Chapter 45 .

Treatment of Anxiety and Related Disorders

In recent years, a number of practice guidelines have been published on the treatment of anxiety disorders. These include guidelines from the Canadian Psychiatric Association on the treatment of all anxiety disorders (Swinson et al., 2006 ), as well as practice guidelines from the American Psychiatric Association on the treatment of particular anxiety disorders, including ASD and PTSD (APA, 2004), OCD (APA, 2007), and panic disorder (APA, 1998; Campbell-Sills & Stein, 2006 ) (note that the American Psychiatric Association's practice guideline for panic disorder is currently being revised). These are welcome updates to older guidelines published by New Zealand's National Health Committee (1998) , as well as Expert Consensus Guidelines for treating OCD (March, Frances, Kahn, & Carpenter, 1997 ) and PTSD (Foa, Davidson, & Frances, 1999 ), developed by Expert Knowledge Systems.

Recommendations from across these guidelines are fairly consistent. They confirm that anxiety disorders are responsive to intervention, and that effective treatments include pharmacological approaches, psychological approaches (particularly cognitive and behavioral treatments), and combinations of these treatments. Part Five of this book provides a detailed review of these strategies for treating anxiety disorders. In this section, we provide a brief overview of effective treatments.

Biological Treatments

Comprehensive reviews of pharmacological treatments for anxiety disorders may be found in Swinson et al. 2006 , as well as in Chapters 22 , 24 , 26 , 28 , and 30 of this volume. Effective medications exist for each of the anxiety disorders, with the exception of specific phobias, where the treatment of choice is almost always behavioral (in particular, exposure to feared situations and objects), though as-needed (p.r.n.) benzodiazepines may have a role for occasional use only. Generally, most first-line pharmacological treatments are antidepressants. For example, there is broad support for the use of selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) for all of the anxiety disorders, except for specific phobia. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine extended-release (and more recently, duloxetine) are also effective for many of the anxiety disorders. Newer antidepressants such as mirtazapine (a noradrenergic/specific serotonergic antidepressant or NaSSA) and reboxetine (a norepinephrine reuptake inhibitor) also show promise for treating several of the anxiety disorders, but much more research is needed. However, older antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs), are used less frequently now than they were in the past because they tend to be more difficult to tolerate and are more dangerous in overdose.

Benzodiazepines (e.g., alprazolam, clonazepam, lorazepam, diazepam), typically introduced as a second-line treatment, primarily because of the risk of dependence, are still widely used—though oft-disparaged—in the treatment of anxiety disorders. There is now emerging evidence supporting the use of several anticonvulsants (e.g., gabapentin, pregabalin) for certain anxiety disorders, though further research is needed. Combining atypical antipsychotics (e.g., risperidone, olanzapine) with antidepressants may lead to improved outcomes for some patients with anxiety disorders such as OCD or PTSD. There is also evidence supporting the use of buspirone for GAD, and beta-adrenergic blockers (taken on a p.r.n. basis) may have a role in the treatment of discrete performance fears (e.g., fears of public speaking), though these medications are not supported for the treatment of generalized social anxiety disorder.

For treatment refractory cases of OCD, there is preliminary evidence from large case series supporting the use of specific neurosurgical procedures (e.g., cingulotomy, bilateral anterior capsulotomy) as a last option, though controlled studies are lacking (see Chapter 28 ). Finally, there is preliminary evidence supporting the use of several herbal products and other alternative treatments for particular anxiety disorders (see Chapter 34 ).

Psychological Treatments

Although there are a few preliminary studies supporting the use of client-centered psychotherapy, brief psychodynamic psychotherapy, and interpersonal psychotherapy for particular anxiety disorders (e.g., Lipsitz, Markowitz, Cherry, & Fyer, 1999 ; Milrod et al., 2007 ; Teusch, Böhme, & Gastpar, 1997 ), almost all research on psychological treatments for anxiety-based problems has focused on cognitive and behavioral approaches (for a review, see Swinson et al., 2006 , as well as Chapters 23 , 25 , 27 , 29 , 31 , 33 , 35 , 36 , and 37 in this volume). Furthermore, some studies have found cognitive behavioral therapy (CBT) to be more effective for treating anxiety disorders than other approaches, such as supportive psychotherapy (e.g., Heimberg et al., 1990 ).

Cognitive behavioral therapy is not a single approach to treatment, but rather one that involves a wide variety of strategies that often differ across patients and across disorders. Although investigators have begun to study transdiagnostic approaches to treating anxiety disorders (see Chapter 33 ), most studies have tended to focus on the treatment of a single anxiety disorder. Evidence-based cognitive and behavioral strategies for anxiety disorders include psychoeducation (e.g., presenting a cognitive model of anxiety; discussing treatment options, etc.), in vivo exposure (i.e., exposure to feared situations and objects), exposure in imagination (e.g., to feared thoughts, images, and impulses), interoceptive exposure (i.e., exposure to feared physical sensations), prevention of compulsive rituals and other safety behaviors, cognitive restructuring (e.g., evaluating the evidence for anxiety-provoking beliefs), relaxation training, mindfulness and acceptance-based approaches, and skills training (e.g., social skills training, problem-solving training).

Variations on these approaches have also been studied. For example, applied tension is an effective treatment for blood and injection phobias. This treatment combines exposure (for reducing fear) with muscle tension exercises (for increasing blood pressure, thereby preventing fainting) (Öst, Fellenius, & Sterner, 1991 ). Exposure-based treatments have also been developed using virtual reality technology, and preliminary studies suggest that computer-generated, virtual reality exposures may be as effective as in vivo exposure for certain phobias (Emmelkamp, Bruynzeel, Drost, & van der Mast, 2001 ). Finally, eye movement desensitization and reprocessing (EMDR; a treatment that combines imaginal exposure with bilateral eye movements, as well as other strategies) has been studied for a number of anxiety disorders, though most of this work has been in the area of PTSD. Although research supports the effectiveness of EMDR for PTSD, there is no evidence that the eye movements add anything to the treatment, and critics have observed that the essential elements of EMDR are similar to those of other evidence-based psychological treatments, including exposure, for example (Lohr, Tolin, & Lilienfeld, 1998 ).

Table 1 lists well-supported psychological treatment strategies for each of the main anxiety disorders, as well as strategies for which support is preliminary, mixed, or tentative.

Combination Treatments

Large trials comparing medication, CBT, and their combination have been conducted for several anxiety disorders, including panic disorder (Barlow, Gorman, Shear, & Woods, 2000 ), social phobia (Davidson et al., 2004 ), and OCD (Foa et al., 2005 ). Preliminary evidence regarding combined treatments also exists for GAD (Bond, Wingrove, Curran, & Lader, 2002 ) and PTSD (Cohen, Mannarino, Perel, & Staron, 2007 ). Although a few studies have found combined treatments to be superior to either medication or CBT alone, most studies across the anxiety disorders have found combined treatments to be equivalent to monotherapies immediately following treatment (Black, 2006 ; Chapter 32 , this volume). However, there is evidence that over the long term (once treatment has been discontinued), CBT alone leads to superior outcomes for the treatment of panic disorder, relative to those following medication alone or the combination of medication and CBT (Barlow et al., 2000 ). The long-term effects of treatment on other anxiety disorders remain to be studied. Also, most studies on combined treatment have studied the effects of beginning CBT and pharmacotherapy concurrently. Additional research on the sequential introduction of CBT and pharmacotherapy is needed.

Anxiety disorders include a diverse group of conditions that share a number of common features, such as a predominance of anxiety and fear, avoidance of feared situations and experiences, and reliance on safety behaviors designed to reduce perceived threat. There is strong evidence supporting the role of biological, psychological, and environmental factors in the cause and maintenance of anxiety disorders. Although anxiety disorders are often chronic conditions, most individuals experience a reduction in symptoms following treatment with medications, cognitive behavioral therapy, or a combination of these approaches. The remainder of this handbook provides detailed reviews on the phenomenology, etiology, assessment, and treatment of each of the main anxiety disorders, as well as for several related conditions.

Support for well-established treatment strategies can be found in Swinson et al., 2006 , as well as in Chapter 23 , 25 , 27 , 29 , 31 , 33 , 35 , 36 , and 37 in this volume.

Although this strategy is often included in treatment protocols for panic disorder, there is little evidence that it adds to treatment outcome overall (Schmidt et al., 2000 ).

Support is still very preliminary, based on a very small number of studies (e.g., Milrod et al., 2007 ; Teusch, Bohme, & Gastpar, 1997 ).

Th is strategy involves combining relaxation training with exposure. Although preliminary studies suggest it is effective for reducing social anxiety (e.g., Ost, Jerremalm, & Johansson, 1981 ), there is no evidence that it is any more effective than exposure alone, and one study found that it is less effective than cognitive therapy (Clark et al., 2006 ).

Success has been reported in a small number of trials using virtual reality for public speaking fears (Anderson, Zimand, Hodges, & Rothbaum, 2005 ; Klinger et al., 2005 ) and interpersonal psychotherapy (Lipsitz, Markowitz, Cherry, & Fyer, 1999 ).

This strategy involves combining relaxation training with exposure. Although preliminary studies suggest it is effective for reducing phobic fear (e.g., in claustrophobia; öst, Johansson, & Jerremalm, 1982 ), there is no evidence that it is any more effective than exposure alone.

A number of studies support the use of virtual reality for height phobias, flying phobias, and other specific phobias. A small number of studies have compared virtual exposure to live exposure, finding few differences (e.g., Emmelkamp, Bruynzeel, Drost, & van der Mast, 2001 ), though more comparative studies are needed.

Success has been reported in a small number of uncontrolled trials (e.g., Roemer & Orsillo, 2007 ).

These strategies have been included in a number of trials of CBT for GAD. However, dismantling studies are needed to determine whether they add any specific benefits beyond the other strategies included in standard treatments.

This strategy has been included in a number of trials on the treatment of OCD. However, dismantling studies are needed to determine whether it adds any specific benefit beyond in vivo exposure and ritual prevention.

Numerous studies support the use of EMDR for treating PTSD, though this treatment appears to be no more effective than other established treatments (Davidson & Parker, 2001 ). There is little evidence that the eye movements contribute to the effectiveness of EMDR, and outcomes are probably related to the effects of exposure and other treatment components (Davidson & Parker, 2001 ; Lohr, Tolin, & Lilienfeld, 1998 ).

Support has been based primarily on small uncontrolled studies and case reports (e.g., Ready, Pollack, Rothbaum, & Alarcon, 2006 ; Rothbaum, Hodges, Ready, Graap, & Alarcon, 2001 ).

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Anxiety Essay: Simple Writing Guide for an A+ Result

Table of Contents

If you’re a Psychology department student, you’re sure to get an anxiety essay assignment one day. The reason for the popularity of this topic today is that people live in chronic stress conditions today, with numerous challenges and pressures surrounding them in daily routines.

In this article, we’ve tried to present a comprehensive guide on composing this type of assignment so that your work on it gets simpler and quicker.

Here you can find:

• Step-by-step instructions on writing essays about anxiety.
• The summary of challenges students face in the preparation of anxiety essay works and ways to deal with them.
• Types of assignments you may face on this topic.
• A list of bulletproof topics to pick when composing an anxiety essay.

How to Write a Thesis for an Essay on Anxiety

Composing a thesis statement is typically the most challenging task for students who are just starting. Your primary goal is to encapsulate your key message in that sentence and to clarify the major arguments you’ll use in the text.

So, here are some tips to make your thesis effective:

• Try to make it not too long and not too short. One-two sentences are enough to communicate the key idea of your paper.
• Focus on the arguments you’ve selected for the paper, and don’t go off-topic. Your readers will expect to read about what they learned from the thesis in the body of your assignment.
• Don’t sound opinionated, but make sure to voice your standpoint. The thesis is your guidance on the point you’ll argue; it’s also the readers’ roadmap through the website content.

With these tips, you’ll surely be much better positioned to complete an anxiety essay with ease. Still, there are some intricacies of the process to keep in mind. Here are our experts’ observations about the challenges you can come across in the process of its composition.

Essay on Anxiety Disorder: Key Difficulties & Differences

Anxiety disorder (AD) is a psychological condition that many people experience in different ways. It differs in manifestations, regularity of symptoms, and intensity. Living with AD is fine for some people as they constantly feel a bit overwhelmed with what’s around them. In contrast, others suffer a permanent disability because of intense worrying symptoms and the inability to concentrate on their work and social responsibilities.

Thus, when composing your anxiety essay, you should be delicate to this sensitive theme, knowing that AD causes real trouble to many people worldwide.

Second, you should be concrete about your selected population. Children, teens, and adults experience AD differently, so your analysis may be incorrect if you talk about children but select scholarly sources talking about adults.

Third, it’s vital to rely on viable clinical evidence when discussing AD. There are differing views on whether it is a severe clinical condition or not. Still, suppose you’re discussing people’s experiences with AD. In that case, it’s better to inform your argument, not by anecdotal evidence from blogs or social media, but to focus on the scholarly articles instead.

What Is a Panic Disorder Essay

A panic disorder essay is a piece of writing you dedicate to the analysis of this disorder. A panic disorder is a specific condition that manifests itself much more intensely than the typical worrying does. Overall, psychiatrists consider it a variety of AD, but this condition is characterized by sudden, intense attacks of panic or fear people experience because of specific triggers.

As a rule, you can diagnose a panic attack by the following symptoms:

• Hot flushes
• A feeling of choking
• Trembling extremities
• Sweating and nausea
• A sudden rise in the heartbeat rate
• Dryness in your mouth
• Ringing in your ears
• A sudden attack of fear of dying; a feeling that you are dying
• A feeling of psychological disconnection with your body (the body parts don’t obey you)

Panic attacks as such as not considered a severe clinical condition. Yet, if people experience them too often and are too concerned about repeated attacks, they should see a psychotherapist and get treatment. Treatment modalities typically include psychotherapy (e.g., talking therapies, CBT) or medications (e.g., antidepressants or SSRI).

Main Steps to Writing a Panic Disorder Essay

When you’re tasked with a panic disorder assignment, the main steps to take in its preparation are essentially similar to those you’ll take with any other anxiety essay:

• You formulate a debatable topic and a clear, informative thesis statement
• You find relevant evidence to support each of your arguments
• You organize your arguments and content into a coherent outline
• You draft the paper and edit it
• You compose a reference list to indicate all external sources and complete the final proofreading of the final draft.

What Is a Social Anxiety Disorder Essay

Social anxiety disorder (SAD) is another form of worrying disorder that people are increasingly diagnosed with today. Clinicians have started taking this condition seriously only a couple of years ago after recognizing that much deeper psychological issues can stand behind what we are used to labeling as shyness. In its severe manifestations, SAD can take the form of a social phobia, which can significantly limit people’s functionality in society, causing problems with schooling, employment, and relationship building.

Still, after recognizing the real problem behind SAD, the psychological community has developed numerous therapeutic and pharmacological ways of dealing with it. So, at present, you can approach the SAD in your essay from numerous perspectives: analyze its symptomatology, the causes underlying SAD development, types of SAD experienced at different ages, and therapeutic approaches to its lifelong management.

Main Steps to Writing a Social Anxiety Disorder Essay

When approaching this type of academic task, you should answer a couple of crucial questions first. What do you know about this topic? Why is it significant? What needs to be clarified on this topic to help people suffering from this condition live better lives? Once you get clear on your writing goals on SAD, it will be much easier to formulate a workable, exciting thesis statement and elicit strong arguments.

Next, you need to research the subject. You’re sure to find much valuable information about SAD in academic sources. Sort the relevant sources out and categorize them by arguments to cite appropriate evidence in each paragraph.

Once you have all the needed sources collected and sorted by argument, you can proceed to the outline of your project. Set the general context in the introduction, define SAD, and clarify why researching this topic is significant. Next, shape all key arguments and develop topic sentences. After that, you can add the relevant evidence in the outline by indicating which source supports which argument.

The next step involves writing the paper’s draft. You should add “meat” to the “bones” of your outline by presenting the data coherently and systematically. Add transitions between paragraphs to enhance the overall flow of the content.

The final step is to edit and proofread the draft to make it look polished and fine-tuned.

20+ Anxiety Essay Topics for Engaging Writing

If you’re still unsure what to include in your essay and what subject to pick, here is a list of attention-grabbing, exciting anxiety essay topics for your use.

• Is anxiety a genetically inherited disorder?
• What environmental factors can cause the development of worries and panic?
• GAD symptoms you can detect in a child.
• What are the symptoms of excessive worrying that require medical assistance?
• Gender differences in the exposure to anxiety disorders.
• Types of clinically diagnosed anxiety disorders.
• Is excessive worrying a personality trait or a clinical condition?
• Are students more anxious and stressed than other population groups because of frequent testing?
• Diagnosis and treatment of AD.
• Does the manifestation of ADs different in children and adults?
• CBT therapy for overly anxious children.
• What is a social anxiety disorder, and how is it manifested in people’s behavior?
• Is feeling permanently anxious cause sleep disorders?
• Correlations between autism and social anxiety disorder.
• Is public speaking a good method to overcome anxiety?
• The therapeutic effects of positive self-talk.
• The social media body image and female teenager anxiety.
• How does low self-esteem reinforce the feeling of anxiety in teenagers?
• The phenomenon of language anxiety among immigrant students.
• The impact of child anxiety on academic attainment, dyslexia, and antisocial behavior.

We Are Here to Help You 24/7

Still, having problems with your essay on anxiety disorder? We have a solution that may interest you. Our experts have all the needed qualifications and experience in writing this type of academic paper, so they can quickly help you out with any topic and any task at hand.

Surprise your tutor with an ideally composed paper without investing a single extra minute into its writing! Contact our managers today to find out the terms, and you’ll soon receive an impeccably written document with credible sources and compelling arguments. Studying without hardships and challenges is a reality with our help.

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Essay on Anxiety Disorder

Introduction

In a world full of socialization and interaction, individuals are known to be affected by mental disorders resulting from environmental and genetic factors. These factors lead to a wide range of behavioral mental patterns, which affect the thinking and behavior of an individual. Therefore, anxiety disorder is a mental illness that accompanies extreme and persistent fear, worry, and anxiety that makes it difficult for an individual to perform their daily events. The challenge in accomplishing the daily events is associated with increased tension, making it hard for the individual to have a stable mental state. Besides, the common anxiety disorders are panic attacks and social phobia. Research shows that approximately 30% of the US population experience anxiety disorders, with women recording high figures. Moreover, scholars have noted that false alarms may be experienced frequently by people with anxiety disorders, causing their bodies to cultivate the flight-or-fight manner in an environment where there is no threat. Further, the false alarms result in uncued panic attack responses on the patients. Remarkably, the panic attack responses are initiated by life stressors such as pregnancy loss and loss or separation of a loved one.

Anxiety Disorder Symptoms

With proper medical attention and care, the devastating anxiety disorders can be managed. Therefore, individuals experiencing anxiety disorders show symptoms such as fatigue. Individuals experiencing the disorder often complain of feeling tired easily. The fatigue mostly happens due to the arousal or the hyperactivity associated with anxiety. However, the fatigue may be related to chronic hormonal effects of anxiety or be aftermath of other anxiety symptoms such as muscle tension or insomnia (Coon et al., 2018). Notably, fatigue is highly recognized to be an anxiety disorder when accompanied by extreme worrying. Secondly, excessive worrying is a significant symptom of anxiety disorder. In response to normal daily situations, hormones may trigger a worry inconsistent with the happening event increasing anxiety. The worrying is disturbing and severe, making it challenging for the affected individual to accomplish their daily tasks. Besides, excessive worrying is considered a symptom of anxiety disorder if it occurs almost daily for more than half a year.

Restlessness is another indicator commonly exhibited by people experiencing an anxiety disorder, and more so in teens and children. Besides, individuals experiencing the disorder may have recurring restlessness in at least six months, making it hard for them to desire to move. Remarkably, restlessness is the most looked at symptom by doctors when making anxiety disorder diagnoses. Moreover, circumventing social situations is evidence of anxiety disorder. For instance, approximately 12% of the adults in America have experienced social anxiety (Twenge et al., 2020). This symptom makes the affected individuals feel humiliated as they address or stand in front of other people, avoid social activities, worry about upcoming social events, and fear being judged by others in social situations. Moreover, individuals having social anxiety appear to be quiet and shy in a group of people and may have depression and low self-esteem.

Showing irrational fears is another anxiety disorder symptom. For instance, individuals express extreme fears towards certain things such as heights, some insects, injections, and closed places. This extreme fear prohibits an individual from functioning normally. Research shows that approximately 12.5% of the American population experience irrational fears in their lives. Lastly, individuals experiencing anxiety disorders show panic attacks (Twenge et al., 2020). The attacks accompany an intense fear, which results in shortness of breath, nausea, rapid heartbeat, trembling, and losing control. Besides, if panic attacks recur, they may be a good sign of anxiety disorder.

Anxiety Disorder Diagnosis

For the necessary medical care, medical practitioners can examine and diagnose the disorder in the affected person by conducting a physical exam. The test helps establish whether the person has anxiety signs, which may be associated with primary medical conditions, hormonal changes, and alcohol or coffee consumption. In addition, for the doctor to diagnose the mental illness, he or she can order urine or blood tests (McDowell et al., 2019). This happens only when a medical ailment is assumed. Therefore, medical professionals can use the blood and urine test to establish whether the patient has hypothyroidism, which may be associated with the displayed symptoms. Moreover, a doctor may ask comprehensive questions to the affected individual concerning their prevailing medical history as well as any symptoms they may be experiencing. Further, doctors can utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to analyze and diagnose the disorder.

Notably, doctors might conduct a psychological assessment to diagnose any fundamental cause of the symptoms shown by the patient. In this diagnosis, a doctor inquires from the affected individual about the symptoms they are experiencing, when they began, what period they have lasted for, and whether they experienced similar symptoms before. The psychological questionnaire may as well ask the patient the ways in which the symptoms affect their day-to-day functioning and activities (McDowell et al., 2019). Besides, scales such as Hamilton Anxiety Scale, Social Phobia Inventory, Generalized Anxiety Disorder Scale, Zung Self-Rating Anxiety Scale, and Yale-Brown Obsessive-Compulsive Scale are used to evaluate the patient’s anxiety level.

Treatment and Psychological theories

The anxiety disorder treatment entails a blending of behavioral therapy, psychotherapy, and medication (Bandelow et al., 2017). For instance, psychological therapy is a typical way of treating anxiety. Besides, Cognitive Behavioral Therapy (CBT) is highly advised in the treatment of anxiety disorder. The CBT comprises efforts to alter and modify the thinking patterns of the affected individual. For instance, CBT can be applied by the counselor, who advises and provides strategies in which the affected person can change their way of thinking, and the meaning they accord to certain events in their lives (Carl et al., 2020). Besides, CBT is applied when addressing panic attacks, depression, social phobia, insomnia, and chronic pains. Therefore, this helps the patient cease fearing that the worst may happen to them; delve into confronting their fears rather than dodging them, and understand, accept, and describe themselves instead of judging themselves. Further, CBT is highly employed where the patient is continually exposed to things that cause them fear, for modeling them.

In addition, behavior therapy can be employed in the treatment of anxiety disorder. The behavior therapy theory is used to model the affected individual’s new behaviors, which they can employ as they respond to their fears, worries, and emotions. This theory is applied by employing negative and positive reinforcement and negative and positive punishment to change the patient’s behavior (Hebert & Dugas, 2019). For instance, the patient is advised to replace maladaptive responses such as fear with adaptive behaviors such as confronting fears or showing courage to overcome. Additionally, the modeling technique employed in Behavior therapy helps individuals imitate the behavior of others facing similar situations as them. Therefore, Behavior therapy is successful as it helps individuals adopt positive responses to different situations.

Lastly, medication can be used to cure anxiety disorders. This may involve medication therapy, which may entail administering medicine such as benzodiazepines, beta-blockers, antidepressants, and tricyclics. Besides, this therapy ensures successful treatment of the disorder as it helps prevent some mental and physical symptoms of anxiety. For instance, antidepressants are useful in curing depression. Therefore, medication therapy treats anxiety disorder by providing medication necessary in countering the mental illness.

Summing up, anxiety disorder is associated with extreme and persistent fear, worry, and anxiety that limit the performance of daily activities of the affected individual. The disorder’s most common forms are panic attacks and social phobia, which have claimed approximately 30% of the American population. Besides, research shows that women are the most affected individuals of the disorder compared to men. Notably, the most common symptoms of anxiety disorders include fatigue, restlessness, circumventing social events, extreme worries, irrational fears, and panic attacks, among others. Remarkably, in diagnosing the disorder, strategies such as administration of the psychological assessment, conducting a physical exam, which entails urine and blood test by doctors, and utilizing the DSM-5. Furthermore, in treating the disorder, medication, behavioral therapy, and psychotherapy are utilized to ensure proper treatment. This leads to the employment of Cognitive Behavioral Therapy and Behavioral therapy theories to ensure modification and change in the behavior of the patient for their benefit. Therefore, these theories are highly recommended for positive changes in the patient’s conduct as well as their mental health.

Coon, D., Mitterer, J. O., & Martini, T. S. (2018).  Introduction to psychology: gateways to mind and behavior . Cengage Learning.

Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A., … & Espie, C. A. (2020). Efficacy of digital cognitive behavioral therapy for moderate‐to‐severe symptoms of generalized anxiety disorder: A randomized controlled trial.  Depression and anxiety ,  37 (12), 1168-1178.

Twenge, J. M., & Joiner, T. E. (2020). US Census Bureau assessed the prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID‐19 pandemic.  Depression and anxiety ,  37 (10), 954-956.

McDowell, C. P., Dishman, R. K., Gordon, B. R., & Herring, M. P. (2019). Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies.  American journal of preventive medicine ,  57 (4), 545-556.

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders.  Dialogues in clinical neuroscience ,  19 (2), 93.

Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder.  Cognitive and Behavioral Practice ,  26 (2), 421-436.

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Anxiety - Essay Examples And Topic Ideas For Free

Anxiety is a common problem faced by many college students. This emotion of feeling worried can be triggered by a variety of factors, including stress from academic work, social pressures, chronic depression, or unease due to personal relationships. Writing a short college essay about anxiety can be challenging, but there are resources available to help you.

That’s why we’ve put together a collection of persuasive and argumentative anxiety essay examples on anxiety that can serve as inspiration for your own writing. Our experts have carefully selected titles and essay topics that cover a range of aspects of anxiety, from its symptoms and disorders to its impact on mental health and well-being.

When writing your own essay, provide a clear thesis statement that outlines your perspective on the topic. You can use the essay samples as a guide for crafting your own outline for your argument, dividing your ideas into coherent and logical paragraphs. Make sure to include a clear introduction that provides background information on the topic and poses thoughtful questions that spark interest in the reader. A conclusion for anxiety essays shall summarize your main points and offer insights into potential areas for future research.

Whether you’re writing a research paper on anxiety or a short essay, be mindful of the language you use. Make sure to avoid overusing terms like “attack” and “fear” to maintain a varied and engaging writing style. By using the essay samples as a starting point and putting your own unique spin on the topic, you can produce an informative and thought-provoking piece of writing that sheds light on this significant issue.

A Research on Struggle with Anxiety

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Nursing Care Generalized Anxiety Disorder

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The Narrator of the Yellow Wallpaper

In the beginning of the story, the narrator explained the house as being a beautiful, silent, far away from the village, gated, and a haunted house. She already described the home as something devil-like possessed and wondered why else the house went on sale for so cheap and why it was abandoned for so long. Has strict rules by her husband to stay in the house all day with some exercise outside in the gated garden. While being indoors all […]

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The Affects of Anxiety on our Lives

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How to Harness your Anxiety?

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A Case of Jake’s Anxiety

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Domestic Violence has effected and still continues to effect the lives of many individuals. Statics on domestic violence states Every 9 seconds in the US a woman is assaulted or beaten Domestic violence is not only found amongst adults but even children and teenagers are victims of domestic violence or are the abuser in an abusive violent relationship .To briefly define and understand Domestic violence, it is an abusive relationship between individuals who abuse one another, aggressively, physically and even […]

Main Reasons of Anxiety

 As you may know, anxiety is within us all.  At some point in our lives, we all have experienced this type of mental state.  No one can blame oneself for it; it just happens when a person is overwhelmed or experiencing high levels of stress.  If one experiences this emotional state, it is important to understand what the signs and symptoms are, as well as risk factors, and how age affects outlook on anxiety in order to help appropriately manage […]

Anxiety: a Widespread Psychological Disorder

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In the Modern World

In the modern world many people suffer from mental disorders that are not physically apparent which in many cases are overlooked. Depression is a mental disorder that creates feelings of hopelessness and despair, and in severe cases, can even lead to suicide. More recent updated ethics have lead people to be more accepting, however, society has a long way to go to fully understand mental disorders. Many factors are contributed to this mental disorder that are uncontrollable. From a psychological […]

Measuring Clinical Anxiety

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Spread of Anxiety in the U.S.

In the U.S. anxiety is an extremely common disorder affecting most people. It is extremely common in the adult population with the highest at risk group for emergence being young adults. Social media has taken over most users using at minimum two forms and pay a visit to them multiple times a day. While it can enhance ones physical well-being at times it can also be a form of stress and anxiety. There isn't much actually known concerning linkage of […]

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African-American Children and Anxiety

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Introduction Cyberbullying became a major concern issue among the youth. Statistics revealed that 44.6% of pupils in secondary school are bullied, with 66% being grade 8 pupils'' (Nekomba, 2015) . According to the oxford dictionary (2014), cyberbullying is defined as the use of electronic communication to bully a person, typically by sending messages of intimidating or threatening nature''. Cyberbullying occur through text messages, and applications or social media. This threatening act involves scaring someone. Social media refers to applications such […]

What Is Generalized Anxiety Disorder

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Anxiety Disorders in Elementary School Children

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What do we Know about Anxiety?

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217 Anxiety Essay Topis & Examples

Looking for anxiety research topics? The issue of anxiety in psychology is hot, controversial, and worth studying!

🏆 Best Anxiety Essay Examples & Topic Ideas

👍 anxiety research topics, ✅ most interesting anxiety topics to write about, 📑 good research topics about anxiety, 📌 catchy titles for anxiety essays, 💡 anxiety argumentative essay topics, ❓ research questions about anxiety.

Anxiety is the emotion that causes severe physical changes, can negatively affect social contacts, and even lead to depression. Here we’ve gathered top research questions about anxiety disorder as a mental health issue, as well as anxiety essay examples. Get inspired with us!

• Social Anxiety Disorder: Female 15-Year-Old Student Since she often downplays her achievements, then it may also be true that Joann expects to fail in the tests or classroom activities.
• Anxiety Disorders: Definition, Causes, Impacts and Treatment Negative reinforcement occurs since the avoidance behavior leads to the avoidance of the discomfort of the anxiety, which is a desirable reward to the individual with anxiety disorder.
• The Generalized Anxiety Disorder According to Bourne, there are a number of treatments that one can refer to in order to curb the generalized anxiety behavior.
• Freud’s Anxiety Neurosis – Psychology The objective of this study is to expose Freud’s anxiety neurosis and to provide a comprehensive approach as to the causes, treatments, and symptoms of the anxiety neurosis.
• Anxiety and Depression Among College Students The central hypothesis for this study is that college students have a higher rate of anxiety and depression. Some of the materials to be used in the study will include pencils, papers, and tests.
• Exam Anxiety: A Descriptive Statistics Study The questionnaire assessed the quality and quantity of sleep because they are significant in determining the level of anxiety and students’ performance.
• The Reiss-Epstein-Gursky Anxiety Sensitivity Index However, the ASI-R is discussed as useful to make decisions regarding the patients’ level of the anxiety sensitivity and associated psychological disorders.
• Diagnosis and Treatment of Anxiety Disorder The classifications of anxiety disorder include the phobias, the generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, obsessive-compulsive disorder, separation anxiety and post-traumatic stress disorder.
• Principal Component Analysis: Anxiety in Students Since students experience anxiety in the course of learning SPSS, the questionnaire aims to measure and ascertain the extent of SPSS anxiety. In essence, the study aims to use PCA in revealing principal variables that […]
• “Status Anxiety” by Alain de Botton Within the ego psychoanalytic theoretical context of the identity statuses, social status ought to refer to the similarity experienced between one’s personal attributes and one’s ego ideal standards, a match that should improve in adolescence […]
• Conflict and Anxiety by Psychoanalysts and Behaviourists This paper shows that the main differences between the psychoanalytic and behavioural interpretations of conflict and anxiety are the conceptions, treatments, and perceived causes of both concepts.
• How Can Students Manage Anxiety As a result, students do not recognize that their mental health state is a result of the anxiety they feel because of the drastic changes that happened in their life and their stress continues to […]
• Glossophobia: The Public Speaking Anxiety The level of fear in public speaking among the male and female participants was determined using a percentage and frequency approach.
• Social Anxiety Disorder Causes and Symptoms Also referred to as social phobia, social anxiety disorder is a psychological condition that is associated with the constant fear of surrounding social conditions.
• Separation Anxiety Disorder (SAD) A routine can help to ease the pain and enable a child to develop trust in both their independence and parents.
• Abnormal Psychology Case Study: General Anxiety Disorder Generalized Anxiety Disorder is one of the anxiety disorders caused by abnormalities in the functioning of brain chemicals such as neurotransmitters.
• Anxiety Measurement: MASC and BAI Two of the most effective assessment tools are the Multidimensional Anxiety Scale for Children and the Beck Anxiety Inventory. The main goal of this paper is to analyze and compare two assessment tools: the Multidimensional […]
• Anxiety Disorder: Mindfulness-Based Stress Reduction The researcher aims to use the tools suggested by Majid et al.and Hoge et al.to evaluate the levels of anxiety in the patient at the beginning of the intervention, during, and after it.
• Comprehensive Psychiatric Evaluation: Recurring Anxiety Attacks CC: The patient is suffering from recurring anxiety attacks whenever she has to leave her house, which is why she has been largely unable to perform basic tasks, as well as communicate with her family […]
• Exercise Eases the Symptoms of Anxiety The review of the literature generally demonstrates the significant effects of exercise in alleviating the symptoms of anxiety. In the future, one needs to focus on patients diagnosed with anxiety and investigate the types of […]
• Depression and Anxiety Among African Americans Finally, it should be insightful to understand the attitudes of friends and family members, so 5 additional interviews will be conducted with Black and White persons not having the identified mental conditions. The selected mental […]
• Generalized Anxiety Behavioral Modification In effect, the primary symptom of GAD is maintained by negative reinforcement such that: people with the disorder worry constantly about a negative event occurring despite its improbability and constant worry leads to distress.
• The Symptoms and Causes of a Social Anxiety Disorder Efforts in public health are required to increase understanding of social anxiety, the difficulties it presents, and the methods for overcoming it.
• Anxiety Disorders and Their Negative Effects The researchers looked to address the effects of anxiety disorders on people’s social, family, affective, and professional lives, as well as to analyze the conviviality of those who suffer from anxiety disorders.
• School Anxiety and Phobia in Children Fear of school is a widespread phenomenon in the modern world, so it is essential to track the symptoms as quickly as possible and eradicate the cause of stress.
• Music Performance Anxiety Alleviation The workshop presentation majored in the discussion of the Music Performance Anxiety, the effect of the condition on violinists, and the therapeutic and medical means of alleviating the conditions.
• Jungian Psychotherapy for Depression and Anxiety They work as a pizza delivery man in their spare time from scientific activities, and their parents also send them a small amount of money every month.S.migrated to New York not only to get an […]
• How to Alleviate the Stage Performance Anxiety of Violinists It is practically due to the lack of a particular definition of MPA and probably the absence of a standard to assure randomized, well-conduct, controlled study trials.
• Meditation Effects on Anxiety and Stress My goal in this exercise was to use meditation to manage anxiety and stress and improve my general mental well-being. I am not accustomed to meditation and had to turn to YouTube for guidance.
• General Anxiety Disorder Pharmacological Treatment Hydroxyzine is the only antihistamine medication approved by the FDA for the treatment of GAD. Other drugs used in the world for the treatment of GAD are not approved for use by the FDA.
• Generalized Anxiety Disorder Diagnostics Were you unable to cope with the excitement and calm down on any occasion in the last 14 days? Was it difficult for you to relax in the last 14 days?
• Anxiety Disorders: Symptoms, Causes, and Classroom Strategies The focus of this paper is on one of the most common types of anxiety disorder, which is generalized anxiety disorder, characterized by a continuous feeling of fear or anxiety that might interfere with day-to-day […]
• Assessing and Treating Patients With Anxiety Disorders According to the provided background information and the results of the mental diagnosis, it is clear that the client is suffering from GAD.
• Psychiatric Evaluation: Sadness and Anxiety She kept up with her counseling sessions and remained on the medication prescribed for her depression well into her early twenties. She has found the cure to be beneficial in controlling her symptoms.
• Discussion: Anxiety Disorder and Obsessive-Compulsive Disorders To be diagnosed with a specific phobia, one must exhibit several symptoms, including excessive fear, panic, and anxiety. Specific phobias harm the physical, emotional, and social well-being of an individual.
• Exam Anxiety as Psychological Disorder The study also focused on finding the relationship between exam anxiety and revision time on the score of students. The findings in this research relate to the current study in that it seeks the relationship […]
• Depression and Anxiety Clinical Case Many of the factors come from the background and life experiences of the patient. The client then had a chance to reflect on the results and think of the possible alternative thoughts.
• Anxiety and Difficulty Concentrating Treatment His siblings have achieved much in their careers, and the self-comparison of Eric to his older brother is a source of anxiety and depressive moods for Eric.
• Anxiety in a Middle-Aged Caucasian Man The primary goal of this decision was to decrease the intensity of the generalized anxiety disorder symptoms in the patient. After four weeks, the client returned to the clinic for the evaluation and discussion of […]
• Generalized Anxiety Disorder and Self-Awareness Based on the article, Panayiotou et al.review the aspect of self-awareness in alexithymia and its correlation with social anxiety. The research provides insight into self-awareness and how it influences anxiety.
• Online Peer Support Groups for Depression and Anxiety Disorder The main objective of peer support groups is connecting people with the same life experiences and challenges to share and support each other in healing and recovery.
• Anxiety Disorder Diagnosis and Treatment Soyara suffered from anxiety disorder and a probable sleep disorder necessitating the comorbid diagnosis. CBT with routine counselling would be the most efficient method of treatment for the anxiety disorder.
• Anxiety Disorder: Pharmacology An increase in the concentration of ACTH and cortisol. Together with the norepinephrine and dopamine systems, the concentration of ACTH and cortisol provides an adequate emotional response to the body.
• The Manifestations of Anxiety: Case Study The nurse also makes frequent clarifications to get a complete picture of the patient’s problem. The nurse often summarizes the information she hears to help the patient keep track of the dialogue.
• Anxiety and Depression: The Case Study As he himself explained, he is not used to positive affirmation due to low self-esteem, and his family experiences also point to the fact that he was not comforted often as a child.
• Perceived Helpfulness of Treatment for Generalized Anxiety Disorder The research is based on the theory of the importance of perceived helpfulness in treatment adherence; the actual findings of the study are detailed and portrayed accurately.
• Moral Identities, Social Anxiety, and Academic Dishonesty In his works, the scholar establishes two explanations for why students indulge in malpractices; the Social anxiety hypothesis and the moral anxiety hypothesis.
• The Adolescent Social Anxiety In adulthood, juvenile rats subjected to recurrent social rejection as a psychosocial theory of stress acquire dopamine hypofunction in the dorsolateral prefrontal cortex.
• Anxiety Disorders: Types and Defense Mechanisms To be diagnosed with an anxiety disorder, a person’s fear or anxiety must be out of proportion to the scenario or age-inappropriate or prevent them from functioning correctly.
• Anxiety Issues Amongst Teenagers One of the most notable stress sources is a feeling of anxiety a state of mind characterized by negative mood and overall tension.
• Generalized Anxiety Disorder and Potential Treatment With the usage of the Benzodiazepines, the drug therapy proved to be relatively efficient and fast-acting. In an example case supplied in the Barlow et al.study, the subject overcame the worst consequences of GAD, although […]
• The Use of Aromatherapy for Patients Anxiety Reduction The target group for intervention to solve the described problem is patients at high risk of anxiety. Question: Among the patients at risk for anxiety, does the aromatherapy reduce anxiety level compared to no aromatherapy […]
• Depression and Anxiety Among Chronic Pain Patients The researchers used The Depression Module of the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale to interview participants, evaluate their answers, and conduct the study.
• The Impact of COVID-19 on Anxiety among Students To be more precise, the authors aimed to investigate whether the transition to a new lifestyle due to the pandemic has impacted the anxiety levels of university youth.
• Anxiety Level of University Students During COVID-19 in Saudi Arabia: Summary The authors aim to highlight the critical intricacies of anxiety and the latter’s relationship with the pandemic, where the primary data collection method was online questionnaires.
• Generalized Anxiety Disorder: Pharmacological Treatment According to its etiology, higher DNA methylation of corticotropin-releasing factor increases GAD risk and severity as do reduced “resting-state functional connectivity between the amygdala and prefrontal cortex” and overactivation of the sympathetic nervous system due […]
• Generalized Anxiety Disorder: Treatment Plan for J. N. As a result, J.N.will be ready to reshape the feeling about possible triggers of his anxiety, as well as actions and behaviors.
• Effective Ways to Address Anxiety and Depression Looking deep into the roots of the problem will provide a vast and detailed vision of it, and will help to develop ways to enhance the disorders.
• The Implementation of Family-Based Therapy to Manage Anxiety Disorder in Adolescents This paper presents a critical analysis of five research articles related to the proposed PICOT question: In a group of patients between the ages of 13-18 with complaints of anxiety, does the implementation of a […]
• Emotional and Anxiety Disorders and Social Cognition Such disorders as obsessive-compulsive disorder, social anxiety disorder, and depression are rooted in childhood, with negative cognitive experiences being the underlying cause for their development.
• Depression and Anxiety Intervention Plan John’s Wort to intervene for her condition together with the prescribed anti-depressant drugs, I would advise and educate her on the drug-to-drug relations, and the various complications brought about by combining St. Conducting proper patient […]
• General Anxiety Disorder Case Stady Like in the case of James, it can be concluded that James is suffering from Generalized Anxiety Disorder, attributed mainly to the kind of pressure he got from his place of work as a resident […]
• Psychedelic Drugs and Their Effects on Anxiety and Depression The participants must also be willing to remain in the study for the duration of the experiments and consent to the drugs’ use.
• Anxiety and Depression in Hispanic Youth in Monmouth County Therefore, the Health Project in Monmouth County will help Hispanic children and adolescents between the ages of 10 and 19 to cope with anxiety and depression through behavioral therapy.
• Anxiety Disorders and Depression In her case, anxiety made her feel that she needed to do more, and everything needed to be perfect. She noted that the background of her depression and anxiety disorders was her family.
• Communication Strategies. Anxiety of Public Speeches The main problem with anxiety is the inability of an individual to persuade the audience. Therefore, the more an individual practices public speaking, the better they will be able to deliver to the audience.
• The Nature of Philosophy: Anxiety As was mentioned by Harry Frankfurt, philosophy is created through anxiety born of an understanding of the limitation of knowledge.
• Anxiety Diagnostics and Screening Have you noticed the changes in your health when you stopped using your HTN medications? Do you observe some changes or problems with your memory?
• Managing Social Anxiety Disorder: Clinical Trial in Psychiatry For instance, the location of the numerical correlation between the use of the identified types of medicine and the subsequent identification of the outcomes can be viewed as crucial to the assessment of the drug […]
• Mobile Addiction and Anxiety: The Relationship Analysis The purpose of the study is to establish the nature of the relationship that exists between mobile addiction and anxiety among students.
• Effect of Preoperative Education on Anxiety of Surgical Patients The education is believed by many medical practitioners to decrease the length of stay in a health facility by providing the patients with substantial information on strategies to adopt to endure and go through psychological […]
• “Effectiveness of Relaxation for Postoperative Pain and Anxiety” by Seers The problem statement and research questions have not been defined but the review of literature reveals that very little work has been done on the topic of effectiveness of relaxation for post operative pain and […]
• Anxiety Among Refugees and the Crucial Need for Professional Interpreters This review appraises three studies examining the issue of anxiety among refugees and the role of professional interpreters in reducing anxiety.
• Anxiety Among Us: How and Why, Drug Addiction As the effects of the drug are not long-lasting, people who take phenobarbital tend to use the medicine more often than it is allowed in the drug prescription.
• Children Healthcare-Induced Anxiety: Analysis Arguably the most crucial difference is that children are often distrustful of medical professionals and scared of physical examinations, and thus adjustments have to be made to make the exam more comfortable. To encourage engagement […]
• Daily Patterns of Anxiety in Anorexia Nervosa The researchers failed to indicate the distinct and important sections such as the study objectives and the significance of the study.
• Local and International Student’s Anxiety In addition to that, international students suffer from anxiety that is caused by the necessity to live in a new environment and culture.
• Depression and Anxiety in Dialysis Patients However, the study indicates the lack of research behind the connection of depression and cognitive impairment, which is a significant limitation to the conclusive statement.
• Social Anxiety. Affecting on Humans The next dependent variable included the revolutionary in the psychopharmacology that led to the production of tranquilizers that were used by the people as a relief of the social anxiety in the 1950s and 1960s. […]
• The Child-Mother Relations: Preventing of the Separation Anxiety Disorder It is important that the researchers defined the issue in the introductory part of the research, as it clarified the criteria for selection of the survey participants and analysis of the study results.
• Treating Adolescents With Social Anxiety At the end of treatment 59% of the SASS group no longer qualified for a diagnosis of social phobia versus 0% of the ESGF group.
• Poor Body Image, Anxiety, and Depression: Women Who Undergo Breast Implants H02: There is no difference in overt attractiveness to, and frequency of intimacy initiated by, the husband or cohabitating partner of a breast implant patient both before and after the procedure.
• Abnormal Behavior: Anxiety, Mood-Affective, Dissociative-Somatoform Considering the abnormal behavior of people, the following disorders may be identified, such as anxiety, mood or affective, and dissociative or somatoform, which have different diagnoses, symptoms, and criteria, which may be analyzed from the […]
• Reducing Anxiety and Depression With Exercise Regardless of the type of results achieved, it is recommendable for people undergoing mental problems like depression and anxiety to exercise regularly.
• Anxiety and the Urge for Victory Among Athletes The challenges of sports presuppose some extent of anxiety and the urge for the victory in the name of a team or something/someone important for a sportsman.
• Aspects of Anxiety Disorders The symptoms of anxiety disorders are so commonly experienced and non-threatening that one is prompted to underestimate the occurrence of such disorders and therefore assume them to be just a minor stress-related anomaly.
• Anxiety and Depression Disorders The cognitive-behavioral model is different from the biological model in that anxiety and depression are seen as a manifestation of intense emotional distress and/or fear. The states of fear, anxiety, and panic are triggered in […]
• The Methods to Reduce Preoperational Anxiety Where as observation of Krohne et al [2005] from the perspective of extending social support appears to have a higher significance than that of the others.
• Relationships Between Anxiety, Perceived Support and Self-Esteem In particular, it sought to determine whether there is a relationship between anxiety, perceived support from friends, and self-esteem whereby anxiety and perceived support from friends act as predictors of the level of self-esteem.
• Anxiety and Phobia in Dental Settings: Theories and Their Relations While external factors may lead to the creation of the anxiety pattern in a patient, the subsequent dental treatment and procedures and their experiences may either exacerbate or altogether nullify the condition.
• Anxiety About Statistics in Undergraduate Students The present study aims to investigate the impact of statistics anxiety on the academic performance of students enrolled in a statistics course.
• Anxiety Disorder in Pregnancy To be precise, the dangers of anxiety disorder during the pregnancy period can equally affect the mother and the unborn child.
• Depression and Anxiety Due to School and Work-Related Stress Many young students are not aware of the roots of their psychological problems and continue suffering from depression or anxiety, which results in low productivity, poor achievements, and a decreased quality of life.
• Anxiety in Children and Its Reasons Moreover, it features vital information about the potential causes of anxiety disorders in children, addressing the role of parents and the environment in the development of the symptoms.
• Anxiety Disorder: Symptoms and Treatment According to Burton, Westen and Kowalski, the common symptoms of panic disorder are the lack of breath, rapid heart rate and pain in the chest.
• Anxiety, Self-Efficacy, and College Exam Grades They conduct a study on 110 students in a variety of majors and gauge their test anxiety and self-efficacy, then collect their results on a test and analyze the results. Notably, they find that the […]
• Anxiety Disorder: Psychological Studies Comparison The research article is expected to investigate the topic of interest from the standpoint of theory and evidence while the pop culture article will give advice and recommendations to its readers.
• Patient’s Dental Fear: Managing Anxiety In order to find out the most effective ways to cope with the patient’s dental fear, one might consider those methods which will be applicable in accordance with the state of a client.
• Optimal Mental Health Approaches: Depression & Anxiety The work of a counselor implies the necessity to understand and recognize the signs and symptoms of mental health problems, as well as find “the missing pieces of reality” that impact innermost lives.
• Test Anxiety and Academic Performance The purpose of the study in question was to investigate the relationship between academic performance and test anxiety. The study was designed to determine causality between the level of test anxiety and average grades of […]
• Anxiety Influence on Studies and Concentration It is a proven fact that anxiety has a negative influence on cognition, which is the ‘information processing’ of a person.
• Generalized Anxiety Disorder and Its Nature For example, Locke et al.suggest that the combination of medication and physiotherapy is particularly effective in cases of moderate and severe GAD.
• General Anxiety Disorder Interventions The authors concluded that the combination of CBT and MI provides a method that allows to minimize possible risks and enhance the effects of CBT.
• Acute Anxiety Impairs Accuracy in Identifying Photographed Faces The researchers wanted to present the best ideas and practices towards improving the performance of eyewitnesses. The authors used the best methods to conduct their study.
• Interviewing the Patient: Stress and Anxiety Reasons Questions Effectiveness How are you, Jonathan? (B) This is a rather bad question, as it is very generic and does not invite the patient to share his emotions with the specialist. On the surface, the question itself is rather harmless; however, when considering it a bit deeper, especially in the given context, one must admit […]
• Anxiety and Depression in Children and Adolescents The effects of anxiety in children and adolescents are detrimental both to individuals and society. It is also said to contain a summary of the current research and theory that have been done by other […]
• Anxiety, Depressive and Personality Disorders There are several features of the depressive disorders, namely the presence of a bad mood, certain changes in the somatic and cognitive functions, and the significant deterioration of functioning.
• Generalized Anxiety Disorder in Female Patient In the client’s case, it is not possible to make a developmental diagnosis because the woman has a bachelor’s degree in journalism obtained at the University of Florida.
• Behaviorism and Anxiety Disorder Treatment Today the behaviorism theory is one of the most developed and reliable theories of psychology because of its methodology and approach that is evident in human behavior.
• Anxiety and Cultural Models in the Conflict The biological concept proposes that anxiety is normally caused by the chemical imbalance which in the long run leads contributes to a genetic panic disorder hence the disorder is likely to be passed down the […]
• Factors of Generalized Anxiety Disorder Prevalence Moreover, the citizens of the developed countries are more likely to observe generalized anxiety disorder than the citizens from nondeveloped countries. Unfavorable environmental factors also can increase the risk of generalized anxiety disorder.
• Addressing the Needs of a Patient With Bipolar and Generalized Anxiety Disorders Furthermore, the patient should restore his connection to his family members since the specified issue contributes to the problem significantly. During the first crisis according to Eriksson’s theory, the patient has experienced abandonment from his […]
• Attention Bias Modification Program in Anxiety Disorder Treatment Thus, it can be argued that in Shana’s case ABM can be applied to reduce current symptoms with a follow up of the CBT to enhance the overall mental health state and minimize negative thinking.
• Drinking and Social Anxiety Among College Students The article “Understanding Problematic Drinking and Social Anxiety among College Students” describes the impact of social anxiety disorder on the experiences of many students.
• Social Anxiety and Facebook Time Spending I chose social anxiety as the concept that might have an effect on the amount of time spent on Facebook each day because of the increasing number of teenagers and young adults who identify themselves […]
• Anxiety Evaluation in Rehabilitation Counseling The research study sought to demystify the facts on the relationships among the stress appraisal process, coping disposition and the level of acceptance of disability on a selected sample for study.
• Emotional Issues: Anxiety and Its Difficulties The patient, therefore, lacks the ability to manage his emotions and handle the pressure of his new responsibilities. Client B.C.is aware of his problems and recognizes the significance of learning.
• Definition of Dental Anxiety and Fear That way, studying the facts that contribute to the prevalence of anxiety in dental patients, the researchers should study the psychopathological profiles of anxious individuals.
• Descriptive Statistics and Statistics Anxiety For example, for the typical cases, the mode, the median, and the mean measures are recommended; for exploring the nature of the distribution of the variable, the test of Skewness or Kurtosis is applied; and […]
• Severe Anxiety Disorder: Diagnosis and Treatment The mental position of the patient explains why it was necessary to refer the patient to a psychiatrist. Family members should also “be equipped with appropriate communication skills in order to address the needs of […]
• Anxiety Disorder: Cognitive Therapy vs. Medications In this essay, the researcher seeks to confirm the hypothesis that medication is not as successful in treating anxiety disorders as the use of cognitive therapy.
• Yoga for Depression and Anxiety A simple definition of yoga will lead people to generalize it as a system of exercise and a kind of mindset that would result in the union of mind and body.
• Sleep Disturbance, Depression, Anxiety Correlation The above imply that many questions are still unanswered with respect to the kinds of sleep complaints affecting undergraduates and the impact on their psychological health.
• Statistics: Anxiety and Sharing Feelings Correlation The means by genders are summarised in the table below. This correlation value was used to determine the nature and strength of the relationship.
• Cognitive Therapy for Anxiety and Addiction Withdrawal The clients’ irrational mindsets can be recuperated relying on three major concepts, which are the Rational Emotive Behavior Therapy, the ABCDE Model, and the Dysfunctional Thought Record.
• Various Anxiety Disorders’ Comparison Lochner explains that physical and emotional abuses suffered in the early years by the individual are predictive to the development of these two anxiety disorders.
• Therapy for Children and Young Patients With Anxiety Disorders This is where the therapists working with the young patients adjust the content and speed of the therapy so that it can match with the level of a particular child.
• Patient Anxiety From MRI Scans Due to the nature of the procedure, the patient can stay in the cylinder for up to an hour depending on the criticality of the examination.
• The Effect of Drug X on Self-Reports of Anxiety in a Sample of Undergraduate Psychology Majors The students will be from the same year of study and the issue of race and color will be considered. Upon the approval of their consent and that of the institution to carry out the […]
• Cognitive Behavioural Family Therapy With Anxiety Disordered Children In relation to definite scope family functioning, the study suggested that parents of anxiety-disordered children have meagre family functioning accompanied with reluctance in monitoring the disparate behaviours in the family.
• Globalization and Culture: Possibilities and Anxieties While the benefits of globalization to the economy cannot be overestimated, still statistics have proven that the world is at a worse state of inequality than it was prior to the emergence of the concept […]
• The Effects of Forgiveness Therapy on Depression, Anxiety and Posttraumatic Stress for Women After Spousal Emotional Abuse Enright forgiveness model applied in the study proved effective since it systematically addressed the forgiveness process identified the negative attributes caused by the abuse, and prepared the women for positive responses.
• Anxiety Disorders in Children and Adolescents The presentation of anxiety disorders in children to be just one of the factors to the disorders among adults as the children grow is an illustration of higher prevalence rate of the disorders in adults […]
• Death Anxiety Is a Multidimensional Concept While concentrating on these dimensions of the death anxiety, it is possible to determine such concrete fears as the fear of dependency, the fear of the pain experienced in the dying process, the fear associated […]
• Acceptance-Based Behavioral Therapy The treatment was randomly administered to 15 of the 31 clients while the remaining 16 clients formed the waiting list control.
• Anxiety, Mood, and Dissociative Disorders The parasympathetic system reverses the activity of the sympathetic system when the danger passes, and restores the body to its resting, pre-anxiety state.
• Attention Biases in Anxiety For instance the primary role of the mechanism responsible for the fear emotion are to allow the identification of threat in the surrounding and to assist the organism react promptly an efficiently to the situation.
• Anxiety, Somatoform, and Dissociative Disorders The impact of these mental disorders varies from minor disturbance in the life of an individual to major problems in the daily activities of the person.
• Fundamentals of Abnormal Psychology: Anxiety Disorders This paper has gone on to reiterate the fact that anxiety disorders are indeed a reality in life and as such, we should brace ourselves for their occurrences.
• Social Status Anxiety and the American Dream The pain of a loss and the status anxiety that came with being inferior to other students at Harvard instigated the urge to revenge and brought a desire to achieve success.
• Frequent Tests as the Ways to Overcome Procrastination and Anxiety The problem can depend not only on the level of the students’ knowledge but also on the degree of the tension and anxiety which are associated with the preparation and review of the material during […]
• Personality, Mood and Anxiety Disorders The first method is used to distinguish personality disorders from anxiety and mood disorders and involves analysis of ego-syntonic features present, chronic causes and early onset of the disorders.
• Generalized Anxiety Disorder: Patient’s Psychological State He feels that his physical, emotional, personal and professional state is in decline, and that is indicative of the seriousness of this psychological disorder.
• Anxiety and Its Types Based on the various facts it can be seen that while anxiety is a common human behavioral condition, the development of anxiety disorders are not and are a direct result of various external stressors.
• Psychology of Behavior: Anxiety Disorders The subjects should be informed of their liberty to participate in the study. In view of the above, negative reinforcement occurred.
• Multiculturalism and “White Anxiety” Takaki provides a neat explanation to this resistance: the white community is afraid of the “non-White majority that is gradually taking shape in the society in the 21th century.
• Mediating and Moderating Effects of Social Support in the Relationship Between Social Anxiety and Hope Levels in Children
• Metacognitive Therapy for Comorbid Anxiety Disorders
• Anorexia Nervosa, Anxiety, and the Clinical Implications of Rapid Refeeding
• Emotional Dysregulation and Anxiety Control in the Psychopathological Mechanism Underlying Drive for Thinness
• Depressive Symptoms, Anxiety Disorder, and Suicide Risk During the COVID-19 Pandemic
• Social Anxiety and Negative Appearance Evaluation as Causes for Eating Disorders
• Anxiety, Depressive Disorders, and Attention Deficit Disorder With Hyperactivity
• Media for Coping During COVID-19 Social Distancing: Stress, Anxiety, and Psychological Well-Being
• Anxiety and Sports Performance: Measurement and Regulation
• Psychosocial and Sociocultural Factors Influencing Antenatal Anxiety and Depression in Non-precarious Migrant Women
• Massage Therapy Reducing Pain, Depression, and Anxiety in Hand Osteoarthritis Patients
• Cognitive Behavioral Therapy for Depression and Anxiety Attacks
• Association Between Depression, Anxiety, and Antidepressant Use With T-Wave Amplitude and Qt-Interval
• The Neuro or Cognitive Mechanisms Behind Attention Bias Modification in Anxiety: Proposals Based on Theoretical Accounts of Attentional Bias
• Yoga and Mental Health – The Benefits of Yoga on Stress and Anxiety in Adults
• Treatments for Depressive, Bipolar, Anxiety, Obsessive-Compulsive, and Related Disorder
• Generalized Anxiety Disorder: Development, Diagnosis, Comorbidity, and Treatment
• Effective Psychological Treatments for Anxiety Disorders: Science, Policy and Economics
• Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders
• Mental Health Issues: Anxiety, Psychosis, and Depression
• The Facts About Anxiety Disorders and Panic Attacks
• The Relationship Between the Physical Activity Environment, Nature Relatedness, Anxiety, and the Psychological Well-Being Benefits of Regular Exercisers
• Brain-Derived Neurotrophic Factor Protein Levels in Anxiety Disorders: A Systematic Review and Meta-Regression Analysis
• Sociological Imagination: Generalized Anxiety Disorder
• Seeing the World Through Non-rose-Colored Glasses: Anxiety and the Amygdala Response to Blended Expressions
• Employee Assistance Programs and Anxiety Disorders
• Problematic Social Media Usage and Anxiety Among University Students During the COVID-19 Pandemic: The Mediating Role of Psychological Capital and the Moderating Role of Academic Burnout
• Context Counts! Social Anxiety Modulates the Processing of Fearful Faces in the Context of Chemosensory Anxiety Signals
• Threat Response System: Parallel Brain Processes in Pain Vis-à-Vis Fear and Anxiety
• Customizing Your Demons: Anxiety Reduction via Anthropomorphizing and Destroying an Anxiety Avatar
• Don’t Stop Believing: Rituals Improve Performance by Decreasing Anxiety
• Anxiety and Personality Disorders: A View of a Client With This Dual Diagnosis
• Resting Heart Rate Variability, Facets of Rumination and Trait Anxiety: Implications for the Perseverative Cognition Hypothesis
• Anxiety and Depression Among Working and Non-working Women
• The Relationship Between Religiosity, Mindful Acceptance of LGBT Identity, and Anxiety
• Symptoms and Long Term Effects of Anxiety Disorders
• Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence From the Framing Effect
• Anxiety Disorders: Post-traumatic Stress Disorder Relating to Rape
• Abnormal Psychology and Secondary Anxiety: Excessive Fear or Worry Related to Behavioral Disturbances
• Traveler Anxiety and Enjoyment: The Effect of Airport Environment on Traveler’s Emotions
• How Can Music Therapy Be Used to Reduce Preoperative Anxiety Blood Pressure?
• Can Financial Literacy Reduce Anxiety About Life in Old Age?
• How Can Aromatherapy Reduce the Level of Stress and Anxiety?
• Does Emotional Intelligence Mediate the Relation Between Mindfulness and Anxiety and Depression in Adolescents?
• How Mental Health Problems Affects People With Anxiety Disorder?
• Does Math Anxiety Impede Working Memory?
• How Anxiety Affects Individuals, and Theis Lives?
• What Are the Risk Factors and Triggers for Anxiety Disorders?
• What Are the Different Kinds of Anxiety Disorders?
• How Can the Christian Faith Help Overcome the Causes and Effects of Anxiety Disorder?
• Can Ethical Leadership Improve Employees Well-Being at Work?
• Can Music Therapy Improve Stress Anxiety?
• How Can You Help Your Child Overcome Anxiety?
• How Anxiety and Depression Are Connected?
• Does Prenatal Valproate Interact With a Genetic Reduction in the Serotonin Transporter?
• How Emotions Affect Logical Reasoning: Evidence From Experiments With Mood-Manipulated Participants, Spider Phobics, and People With Exam Anxiety?
• How Prevalent Are Anxiety Disorders?
• Does Writing Help Cope With Anxiety or Panic Attacks?
• Why and How Adolescents Are Affected by Generalized Anxiety Disorder and Clinical Depression?
• What Are the Treatment Options for Anxiety Disorders?
• How Can Performing Everyday Tasks Be Difficult With Anxiety?
• Does Anxiety Affect Adolescent Academic Performance?
• Does Social Anxiety Lead to Depression?
• How Have Psychological Theories Elucidated the Nature of Anxiety Regarding Panic Disorder?
• Can Anxiety Affect Eyewitness Testimony?
• How Does Watching Television Affect Anxiety Levels in Children?
• Does Self-Efficacy and Emotional Control Protect Hospital Staff From COVID-19 Anxiety and Ptsd Symptoms?
• Does Despotic Leadership Harm Employee Family Life: Exploring the Effects of Emotional Exhaustion and Anxiety?
• How Does Anxiety Affect Language Learning?
• Who Is at Greatest Risk of Developing an Anxiety Disorder?
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I Thought I Hated Napping. But Actually, I Just Had an Anxiety Disorder.

Until I was 32, I would have told you that "I'm not much of a napper." I might even mention how my aversion stretched back into childhood; my mom always told me that I stopped taking naps around the age of 4. I don't know what put me off of the practice back then, but as a teen and young adult, whenever I tried to nap, there were usually two outcomes: racing thoughts wouldn't let me fall asleep no matter how exhausted I was, or I would fall asleep only to wake up feeling groggy and disoriented .

All of that changed in 2022, when I sought help — again — for my anxiety at a free clinic in my hometown.

"I've tried every natural remedy under the sun, and it's just not cutting it. Exercise, CBD, yoga, self help books and podcasts — you name it," I told the nurse who took my vitals on the day of my first appointment.

What I didn't tell her: I'd also visited a different clinic years earlier to get help with my anxiety symptoms , but I wasn't taken seriously. The medical professional cut me off mid-sentence and wrote me a prescription for an antihistamine. It didn't do anything to ease my racing thoughts, frequent nightmares, and tendency toward avoidance, and it gave me brain fog and made me drowsy, so I threw most of those pills away.

The experience discouraged me from seeking treatment again until 2022, when my anxiety had become so unbearable it was life-threatening. This time, thankfully, the healthcare provider I ended up meeting actually listened to me and took me seriously.

I discussed my anxiety symptoms and health history — which included depression and chronic pain — with the free clinic's nurse practitioner, and she wrote me a prescription for duloxetine, an antidepressant that also treats anxiety and certain types of chronic pain. I started taking the medication the next day, and I felt relief with my first dose. It's one of the best decisions I've ever made.

Treating my anxiety with medication was life-changing in numerous ways. I felt calmer in social situations, I had fewer nightmares, and I stopped avoiding important tasks, like getting my medical power of attorney filled out and notarized.

But unexpectedly, treating my anxiety also completely changed my relationship with napping . When I used to tell people I wasn't "much of a napper," I would say things like "I just can't turn my brain off during the day" to describe what would happen when I would lie down and close my eyes: how my thoughts would go into overdrive rather than calm down; how I would begin to feel agitated and impatient; how it would become so stressful to try to lie still and drift off that I'd give up, seeking the relief of distraction.

I can't remember the first time I took a nap after I started taking medication , but I do remember the first time I talked about how much I love napping. "Napping on the weekends is one of my great joys now," I said to my sister at a family gathering. "There's nothing quite like a daytime couch nap on my day off." I think I surprised us both.

If anything can illustrate the power of anxiety treatment, it's that these days, napping is my go-to move when I need a mental reset — which makes sense, because the health benefits of napping include improved mood. It's as much a part of my self-soothing routine as exercising, cleaning, and skincare. If I'm overstimulated after a family gathering, I'm going to take a nap. If I'm completely drained after a day of running errands, I'm going to take a nap. If I'm triggered by something I heard at work, I'm going to take a nap. If I have a bad night's sleep — as I did recently, when anxiety about my book signing woke me up way too early — I can take a nap later that day, and it's glorious.

It's impossible to overstate how essential treating my anxiety was, and continues to be, for my health and happiness. Finding an effective anti-anxiety medication saved my life. But it also enriched my day-to-day in so many small ways, touching areas of my life that I had no idea were affected by my anxiety — like my relationship to napping. I love napping so much now that it's hard to believe I ever hated it, and I know I can thank my anti-anxiety medication for that.

Elizabeth "Liz" Enochs is a queer writer from southeast Missouri. She's the author of the nonfiction prose chapbook "Leaving the House Unlocked."

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• Published: 07 November 2023

Social virtual reality helps to reduce feelings of loneliness and social anxiety during the Covid-19 pandemic

• Keith Kenyon   ORCID: orcid.org/0000-0002-5084-9024 1 ,
• Vitalia Kinakh 2 &
• Jacqui Harrison 1  

Scientific Reports volume  13 , Article number:  19282 ( 2023 ) Cite this article

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Evidence shows that the Covid-19 pandemic caused increased loneliness, anxiety and greater social isolation due to social distancing policies. Virtual reality (VR) provides users with an easy way to become engaged in social activities without leaving the house. This study focused on adults, who were socialising in Altspace VR, a social VR platform, during the Covid-19 pandemic and it explored whether social VR could alleviate feelings of loneliness and social anxiety. A mixed-methods research design was applied. Participants (n = 74), aged 18–75, completed a questionnaire inside the social VR platform to measure levels of loneliness (UCLA 20-item scale) and social anxiety (17-item SPIN scale) in the social VR platform (online condition) and real world (offline condition). Subsequently, a focus group (n = 9) was conducted to gather insights into how and why participants were using the social VR platform. Findings from the questionnaire revealed significantly lower levels of loneliness and social anxiety when in the social VR platform. Lower levels of loneliness and social anxiety were also associated with participants who socialised with a regular group of friends. In addition, findings from the focus group suggested that being part of an online group facilitates stronger feelings of belonging. Social VR can be used as a valuable intervention to reduce feelings of loneliness and social anxiety. Future studies should continue to establish whether social VR can help to encourage group formation and provide people with enhanced social opportunities beyond the COVID-19 pandemic.

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Introduction.

On the 11th March 2020 the World Health Organisation declared the rapidly spreading Corona virus outbreak a pandemic 1 and world governments began to impose enforced social isolation rules. Throughout 2020/2021 the majority of countries imposed lengthy periods of lockdown. The first UK lockdown lasted almost 4 months and during this time only essential travel was permitted and interaction with others from outside the direct household was forbidden 2 . The lock-down caused disruption to daily routines, social activities, education and work. Social distancing measures led to a collapse in social contact. When people experience a reduction in social contact or when the quality of interaction with others is diminished, they can suffer feelings of loneliness. Nearly 7.5 million adults experienced "lockdown loneliness," which is the equivalent to around 14% of the population. 3 Additionally, the percentage of the UK population reporting loneliness increased from 10% in March 2020 to 26% in February 2021 4 .

Social isolation and loneliness

Social isolation and loneliness are different. Social isolation is commonly defined as “the state in which the individual or group expresses a need or desire for contact with others but is unable to make that contact” 5 , p. 731 . Social isolation can occur due to quarantine or physical separation. Due to quarantine measures enforced during lockdown, people faced involuntary social isolation or at least a reduction in their social interactions to the point that their social network was quantitatively diminished 6 . Loneliness is a subjective experience that arises when a person feels that they are isolated and deprived of companionship, lack a sense of belonging, or that their social interactions with others are diminished in either quantity or quality 7 .

Social isolation, loneliness and detrimental implications for physical and mental health

The rise of loneliness during lockdown also increased the prevalence of anxiety 3 and such health problems as depressive symptoms and insomnia, reconfirming findings from earlier research 8 that explored the relationship between social isolation and loneliness and the effect it has on our physical and mental health. Loneliness can lead to stress and high blood pressure, a sedentary or less active lifestyle, and a reduction in cognitive function 9 , 10 , 11 . Loneliness can also lead to less healthy behaviours e.g. an increase in alcohol consumption and smoking 12 , a poor diet 13 and poor sleeping patterns 14 . Loneliness has been found to have an impact on a person’s social wellbeing leading to feelings of low self-esteem and worthlessness as well as increased anxiety and decreased levels of happiness, resulting in depression 11 , 15 , 16 , 17 .

Technology-based interventions to reduce social isolation and loneliness

Within the last decade several systematic reviews have focused on technology-based interventions for people who are experiencing or who are at risk of experiencing loneliness and social isolation 18 , 19 , 20 , 21 . Masi et al. 18 in their meta-analysis, explored the efficacy of technology-based vs non-technology-based interventions across all population groups, notably, the mean size effect for technology-based interventions was − 1.04 (N = 6; 95% CI  − 1.68, − 0.40; p  < 0.01), as opposed to − 0.21 (N = 12; 95% CI  − 0.43, 0.01; p = 0.05) for non-technology-based interventions. Choi et al. 19 reported a significant pooled reduction in loneliness in older adults after implementing technology-based interventions (Z = 2.085, p  = 0.037). Early technology-based interventions consisted of conference calls/video conferencing, text-based Inter Relay Chat and Emails 18 , 19 , 20 . Subsequent systematic reviews 21 , 22 found that video conferencing was able to reduce loneliness in older particpants, however, this technology only helped to facilitate communication between existing, rather than new contacts. These types of intervention are therefore less beneficial for individuals who are socially isolated and struggling to establish connections with others.

During the Covid-19 lockdowns there was no possibility to provide or continue providing face-to-face individual or group interventions for lonely people. Moreover, even non-lonely people found themselves in situations where they could not maintain their social relationships through face-to-face interactions. Thus, the Department of Primary Care and Public Health in England recommended that avenues for mitigating feelings of loneliness should look to include web- and smartphone-based interventions 23 .

Virtual reality (VR) using a head mounted display (HMD) is considered qualitatively different from other technologies in that it has the ability to provide a sensation of immersiveness or ‘being there’ 24 . VR technologies are becoming more accessible and comfortable with the creation of lighter more portable HMDs at a more affordable cost. This allows the technology to be used by a greater range of adults and members of vulnerable groups, e.g. adults with mobility impairments and older adults with age-related impairments. VR users, often represented as avatars, are able to meet and communicate in real-time with each other within a range of different scenarios. People are able to participate in social activities with new people, e.g. venturing off into new and exciting worlds (with nature scenes) 24 , travelling to different destinations around the world 25 , 26 without leaving their homes and escaping their confined realties or engaging in horticultural therapeutic interactions 27 . Older adults are able to engage in social networking activities, including playing games with other people and attending family events through VR, users spoke very positively and expressed visible signs of enjoyment about their experience 28 , 29 , 30 . Virtual gaming is very popular among younger users with 31 , 32 reporting that players experience significantly lower levels of loneliness and social anxiety when playing VR games compared within the real world.

Users taking part in VR interventions report being less socailly isolated, show less signs of depression, and demonstrate greater levels of overal well-being 24 , 25 , 26 , 27 , 33 , 34 . Widow(er)s in a VR support group showed a significant improvement during an 8-week intervention 35 . While both systematic reviews 33 , 34 reported useful insights regarding the positive impact of VR technology on loneliness, most studies on VR environments included a small number of participants from specific populations, thus the reported findings have limited generalisability.

When VR is used as an intervention to reduce social and public speaking anxiety, it is found to be most effective as a mode of delivery for alternative therapeutic interventions such as Acceptance and Commitment Therapy 36 . Furthermore, Kim et al. 37 found that patients with Social Anxiety Disorder (SAD) benefitted from the use of VR as an intervention, evidenced by short-term neuronal changes during exposure. They concluded that VR is useful as a first intervention for SAD patients who are unable to access formal treatment.

Various social VR platforms have emerged since 2013, e.g. VRChat, Altspace VR and RecRoom, however, the use of social VR as an intervention for reducing social isolation and loneliness is still a relatively new and unexplored field. Therefore, whilst there is research to support the effectiveness of VR as a tool to deliver therapeutic interventions and improve social well-being, there is limited research on the use of social VR as an online mechanism to decrease social isolation and improve group belonging.

Innovation and contributions of this study

The current study is a cross-sectional study of the general population, socially isolated during the Covid-19 pandemic and who were using social VR platforms to interact with each other. This study addresses the limitations of previous studies, which have focused exclusively on specific groups within the population, i.e. older adults or VR gamers, or explored general well-being rather that loneliness and social anxiety. In previous studies the HMDs were often provided by the research team, meaning that there was a time restrain (frequency or length) in relation to the use of the VR technology by participants. This study is novel as it explores the effects of loneliness and social anxiety on a wider demographic of people, who have unrestricted access to HMDs and have been socialising in Altspace VR during the Covid-19 pandemic. This study is of an international character and utilises a mixed methods approach to explore the benefits of social VR to help reduce feelings of loneliness and social anxiety and to provide additional means by which social contact can be enhanced for vulnerable populations who may remain isolated post-pandemic.

Research hypotheses

The following hypotheses were explored:

Lower levels of loneliness and social anxiety are experienced when participants are in the social VR platform (online) compared with in the real-world condition (offline).

Lower levels of loneliness and social anxiety are experienced by participants who are part of a group in social VR, i.e. members of a Virtual Social Group (VSG), than those who are not.

Lower levels of loneliness and social anxiety are experienced by participants who have a group of friends in the social VR in comparison with those who do not.

Lower levels of loneliness and social anxiety are experienced by participants who spend greater amounts of time in social VR.

The study used a convergent parallel mixed-methods research design 38 to collect both diverse quantitative and qualitative data (see Fig.  1 ). The study complied will relevant ethical regulations and was approved by the Research Ethics Committee of the University of Bolton, UK. Written informed consent was obtained from all participants.

A convergent parallel mixed-methods model of the current research.

Collection of quantitative data

Participants.

Participants were required to be English speaking, over the age of 18 and users of Altspace VR. A message of invitation was posted on different Discord community channels/message boards: Official Altspace VR; Educators In VR; Spatial Network; Humanism; Computer Science in VR; VR Church. 87 participants were recruited via an opportunity sampling method.

Materials and measures

A private research room was created inside Altspace VR to ensure that participants were able to complete the questionnaire undisturbed (see Fig.  5 ). The online questionnaire was created in Qualtrics XM and could be accessed across multiple devices: Oculus Quest, Oculus GO, Oculus Rift, HTC Vive and PC. The online questionnaire included sections about demographics, details of Altspace VR usage and sections assessing participant’s subjective feelings of loneliness and social anxiety. Measures of loneliness and social anxiety were collected for both conditions—real world (offline condition), followed by social VR (online condition).

The UCLA Loneliness Scale version 3 39 was used to measure the subjective level of loneliness. This 20-item self-reporting questionnaire uses a four-point Likert scale, with 0 = “Never”, 1 = “Rarely”, 2 = “Sometimes”, 3 = “Often”. The loneliness score for each participant (range from 0 to 60) was determined as the sum of responses to all 20 items—higher scores reflecting greater loneliness. The UCLA Loneliness scale was adapted to include the word Altspace in the online condition as it was felt that this would further help participants to focus specifically on the online experience. No further adaptations were made to this questionnaire. The Social Phobia Inventory (SPIN) scale 40 was used to measure the subjective level of social anxiety as it is effective in measuring the severity of social anxiety. This 17-item self-reporting questionnaire uses a five-point Likert scale, with 0 = “Not at all”, 1 = "A little”, 2 = “Somewhat”, 3 = “Very much”, 4 = “Extremely”. Adding the scores from each item produced a SPIN score for each participant. A higher SPIN score indicates more severe symptoms of social anxiety. No adaptations were made to the SPIN questionnaire.

Participants who were interested in taking part in the survey were taken to the research room inside Altspace VR where they were sent a message with a link to the online questionnaire. Participants who clicked on the link were then presented with a browser window inside the room that only they could see. Participants who opened the questionnaire were first presented with the participant information sheet giving full details of the study. Information regarding withdrawal from the study and a list of additional support services were also provided in line with the University of Bolton’s ethical guidelines. After reading the study information sheet, participants were presented with the consent form for which full consent was required before they were able to move onto the survey.

The strategy for dealing with incomplete cases was to remove any participants who did not answer all of the questions, thus analysis was conducted on 74 participants. Exported data from the Qualtrics system was imported into the Statistical Package for Social Sciences (IBM SPSS, version 25). A Kolmogorov–Smirnov test ( p  > 0.5) was carried out to test for a normal distribution and histograms, nominal Q-Q plots and box plots were used to identify any outliers. Two outliers were found in the data for Social Anxiety in the offline condition and these were replaced with the mean of 17.54 .

Characteristics of the sample

Of the total sample (n = 74), 46 were males and 28 females. The age range of respondents was 18–75 years (the split of valid participants is shown in Table 1 ). Participants were recruited globally (the geographical demographic is shown in Fig.  2 ). Out of these 74 participants, 31 participants (15 males, 16 females) were new to Altspace VR, having joined Altspace VR during the Covid-19 pandemic. 43 participants indicated that they had used Altspace VR before the outbreak of Covid-19.

Participant’s location.

Change in loneliness and social anxiety

Figure  3 shows the breakdown of social anxiety scores in both the online and offline conditions. The data shows that the severity of social anxiety is higher in the offline condition, whereas participant’s levels of anxiety reduce when they are online.

Participant’s SPIN Scores.

The UCLA loneliness scale uses continuous scoring and so it is not possible to provide a similar breakdown for participant’s levels of loneliness. The effect that social VR has on the participant will be discussed in greater detail later.

It was anticipated that during the Covid-19 pandemic and as a direct result of social distancing rules being imposed that general usage in Altspace VR would increase. Figure  4 shows that 76% of participants felt that their usage had increased and after calculating the average difference in usage (before and during Covid-19) an average increase per user of 11 h per week was reported.

Participants usage of Altspace VR since Covid-19.

Hypothesis 1

Hypothesis 1 predicted lower levels of loneliness and social anxiety are experienced when participants are in social VR (online) compared with in the real-world condition (offline) A paired-samples t-test was carried out to compare online (inside social VR) and offline (real-world) conditions for both loneliness and social anxiety. The results in Table 2 demonstrate a statistically significant decrease in the scores for loneliness from the offline condition (M = 20.53, SD = 14.80) to the online condition (M = 16.32, SD = 11.04), t  = − 2.573, p  < 0.05. A statistically significant decrease in social anxiety was found in the offline condition (M = 23.01, SD = 16.65) compared to the online condition (M = 16.34, SD = 13.09), t  = − 5.80, p  < 0.05. A small to moderate effect size 41 was found for both variables (i.e. d loneliness = 0.32 and d social anxiety = 0.45).

Hypotheses 2, 3 and 4

H2 predicted that lower levels of loneliness and social anxiety are experienced by participants who are part of a group in social VR than those who are not.

Being a member of a VSG means that the participant meets with a group or number of groups on a regular basis to take part in scheduled events, e.g. regular church services for members of VR Church; discussions around education each week for members of Educators in VR; mediation and relaxation sessions for members of the EvolVR group; and discussions on a whole range of matters relating to life in the Humanism group. 75.7% of participants (n = 56) indicated that they were a member of a VSG and 24.3% (n = 18) were not affiliated with any groups.

A one-way between participants ANOVA was carried out to compare the effect of being a member of a VSG separately for each of the dependent variables. No significant effect was found for loneliness in both the online condition F(1,72) = 0.17, p  = 0.68 and offline condition F(1,72) = 1.63, p  = 0.20. No significant effect was found for social anxiety in the online condition F(1,72) = 2.22, p  = 0.14, however, a significant effect was found for social anxiety in the offline condition F(1,72) = 4.23, p  < 0.05, η 2  = 0.06 (a medium effect size). This finding suggests that participants who are part of a VSG experience less social anxiety (M = 20.80, SD = 15.64) than those who are not (M = 29.89, SD = 18.26) when in the real world (offline) condition.

H3 predicted that lower levels of loneliness and social anxiety are experienced by participants who have a group of friends in social VR in comparison with those who do not. This differs from Hypothesis 2 in that having friends in Altspace VR is seen as a deeper connection than simply taking part in group events where connections may not have been formed. Participants were grouped on whether they have a circle of friends in social VR with whom they regularly socialise with (52.7%, n = 39) and not (47.3%, n = 35).

A one-way between participants ANOVA was carried out to compare the effect of having a circle of friends separately for each of the dependent variables. A significant effect was found for loneliness in the online condition F(1,72) = 6.75, p  < 0.05, η 2  = 0.08 (a medium effect size), whereas no significant effect was found for loneliness in the offline condition F(1,72) = 0.03, p  = 0.86. This suggests that participants who have a circle of online friends experience less loneliness (M = 13.28, SD = 11.02) than those who do not (M = 19.71, SD = 10.17). A significant effect was found for social anxiety in both the online condition F(1,72) = 6.82, p  < 0.05, η 2  = 0.09 (a medium effect size) and offline condition F(1,72) = 9.18, p  < 0.01, η 2  = 0.11 (a large effect size). This suggests that participants who have a circle of online friends experience less social anxiety (M = 12.72, SD = 12.64) than those who do not (M = 20.37, SD = 12.54) in both online and offline conditions.

H4 predicted that lower levels of loneliness and social anxiety are experienced by participants who spend greater amounts of time in social VR. There was a reasonable balance of participants who have been members of Altspace VR for more than 6 months prior to (n = 43) and who joined during (n = 31) the Covid-19 pandemic.

A one-way between participants ANOVA shows a significant effect for loneliness in the online condition F(1,72) = 4.68, p  < 0.05, η 2  = 0.06 (a medium effect size), whereas no significant effect was found for loneliness in the offline condition F(1,72) = 0.08, p  = 0.93. This suggests that participants who have been members of Altspace VR for more than 6 months experienced less loneliness (M = 14.02, SD = 11.63) than those who joined during the Covid-19 pandemic (M = 19.52, SD = 09.43). No significant effect was found for social anxiety in the online condition F(1,72) = 2.13, p  = 0.15, however, a significant effect was found for social anxiety in the offline condition F(1,72) = 4.77, p  < 0.05, η 2  = 0.06 (a medium effect size). This suggests that participants who have been members of Altspace VR for more than 6 months experienced less social anxiety (M = 19.51, SD = 16.82) than those who recently joined (M = 27.87, SD = 15.38).

Discussion of quantitative results

Research into the use of web-based technologies and virtual worlds has consistently demonstrated positive effects of such interventions on an individual’s subjective feelings of loneliness and social anxiety. Hypothesis 1 of this study is therefore supported and is consistent with the earlier findings 31 , 32 , 42 , 43 and a recent review 44 .

The results of this study in relation to hypothesis 2 were unable to support the assumption that being part of a VSG will reduce feelings of loneliness. The study was therefore unable to support findings from 32 which reported that VR gamers who played as part of a guild were less likely to experience feelings of loneliness. Social identity theory 45 provides a possible explanation for this. Teaming up with a specific VR gaming guild with the common purpose of defeating an enemy for example exerts a stronger sense of identity and group attachment compared to belonging to multiple virtual social groups, where an individual could have several social identities, thus group attachment is less salient. Furthermore, group attachment takes time to develop and within Altspace VR new VSGs are being created all the time. Future studies should look to explore the relationship between the membership duration and the strength of group attachment and the effect this has on subjective feelings of loneliness.

The results of this study support hypothesis 3 in that participants, who have a circle of friends with who they regularly socialise in social VR, experience lower levels of loneliness and social anxiety. This is consistent with the findings of 32 who found that playing with known people helps to reduce feelings of loneliness and social anxiety. This also further supports the findings of 46 who found that half of participants considered their gamer friends to be comparable to their real-life friends. As pointed out by 47 in the Need to Belong Theory, people need frequent and meaningful interactions to feel fulfilled. The ability to form positive social interactions with people with which we feel most connected, i.e. a circle of friends that share our goals or with which we have a common purpose, promotes greater levels of satisfaction and generates greater feelings of belonginess, which in turn reduces our feelings of loneliness and social anxiety 48 .

The results of this study in relation to hypothesis 4 support the assumption that the longer a person has been in social VR the lower will be their feelings of loneliness. There was a significant reduction in feelings of loneliness in the online condition, but not in the offline condition. The explanation for the divergence is that both new and existing Altspace VR users were experiencing similarly high levels of loneliness in the real-world condition, due to the sudden enforced period of lockdown that was imposed upon them, and that whilst being in social VR for a longer period of time showed a greater reduction in feelings of loneliness, in the real world the length of time they had been using social VR was not significant. A possible explanation for this is that when returning to the real world a person is again faced with the challenges of the imposed social isolation and will therefore continue to experience greater levels of loneliness. The reverse situation was found for social anxiety with a significant reduction in social anxiety being found in the offline condition for participants who had been using social VR for longer. This is a useful finding because it shows that using social VR for longer periods of time can help to reduce feelings of social anxiety in the real world. As is suggested by 42 social VR can be used to build up social capital and thereby help to improve a person’s social skills in the real world.

Focus group

Nine participants (6 male, 3 female) who took part in the online questionnaire were later recruited to take part in a focus group. The demographics of this group are shown in Table 3 . The focus group was made up of a wide mix of people from around the world. Participants were a mix of educators, students, developers and other professionals. Four of the participants were new to Altspace VR, having joined during the Covid-19 pandemic, whilst five had been in Altspace VR for more than 6 months. All the participants had previously attended at least one Educators in VR research event.

The focus group study took place in a private research room inside of Altspace VR (see Fig.  5 ), purposely created by the researcher. Only selected participants were able to join this room via a portal link provided by the researcher. The interview was recorded using OBS screen recording software on the researcher’s computer.

Virtual research room.

Prompts were kept to a minimum and questions were open-ended to elicit rich responses from participants. The focus group was later transcribed verbatim by the researcher. The transcript was analysed using a thematic data analysis approach as per the Braun and Clarke framework 49 . Thematic analysis is a suitable analytic approach to systematically establish patterns of meaning within qualitative data sets 50 . Microsoft Word was used to facilitate data management and the coding of themes. Participants’ responses were coded and themes identified.

Qualitative results

Four superordinate themes with several subordinate themes were identified (see Table 4 ).

Theme 1. Why the participant visits the social VR platform

Participants spoke freely about how they got involved in Altspace VR and what they believe to be the main reason they visit Altspace VR. Three sub-themes were discovered, although from the discussions it was clear that most, if not all, participants, valued the group interaction and attendance at events very highly.

Socialising in VR

What was interesting about the group of participants in the focus group was that they were all connected due to their involvement with the Educators in VR community and not through friendship ties. Some participants highlighted that they initially joined Altspace VR to meet new people and then started building a network of professional relationships.

Participant quotes from the transcripts are given within the results section for each subordinate theme. For confidentiality purposes quotes from participants will be referenced as: Participant (P), followed by a number 1–9 and the participant’s gender M (male), F (female) e.g. “P1M”.

“In VR I hang out with friends and of course the [Educators in VR] research team, but I don’t hang out around the campfire as much anymore” (31-33,P3F).

The campfire in Altspace VR is a meeting place for new users to mingle, chat and make friends. New users to Altspace VR tend to levitate towards the campfire until they establish friendship groups and events in which to take part in. This participant has already established a network of meaningful friendships and they are now spending less unstructured time in social zones.

All participants highlighted that they had seen an increase in their usage during the Covid-19 pandemic. The imposed restrictions on physical meetups led to several participants using social VR to meet with real-world friends to satisfy their social needs.

“During this pandemic I have probably come in an hour or two more per day. Part of that was to connect with some of my friends. I got some friends to start coming into Altspace VR so we were able actually hang out in Altspace” (52-55,P5F). “more recently, in the last month or so, because I work in the VR community and a lot of my personal friends have VR headsets, the people that I work with at the university, The people that are in my groups and in my sphere so to speak at the university are some of my best friends and so we have started having social meet-ups in VR for nothing other than social, like just for social meet-ups” (125-132,P1M)

Attending community events and learning new skills

All of the focus group participants recognised the value of taking part in regular events in social VR. In particular, participants were positive about the opportunities that exists within Altspace VR to collaborate with others to expand and learn new skills. Community involvement within Altspace VR generates a strong sense of belonging thus reducing feelings of loneliness and social anxiety.

“I got inspired by the Covid situation to host events, so it inspired me to bring people together. I think if the Covid situation did not happen I wouldn’t have organised these research meetings to be honest, so it was pretty much the catalyst to hosting events” (161-165,P3F) “One thing I love about the Altspace environment is the Educators forum because I have joined philosophy classes, I’ve done Psychology classes, I’ve really interacted. In fact, I started a talk show, [ ] my own event, and that’s one thing that I love about Altspace, so I do love this place” (72-78,P7M)

Sharing ideas with professionals and like-minded people

Altspace VR allows users to create their own events and to share knowledge with other users. There are a wide range of different interest groups within Altspace VR. Establishing common interests with others is a cornerstone to forming positive and meaningful relationships. Establishing a network of contacts is also beneficial by encouraging, giving advice and supporting each other in difficult times 51 . Several of the participants commented that social VR is a useful tool not least during periods of enforced social isolation, but also to those who find themselves unable to form such relationships within their existing real-world social networks.

“I entered Altspace mainly for the Educators in VR conference and after that, during the Covid crisis obviously I stayed because it is a perfect place to find people that have a similar interest with mine” (62-64,P6F). “It’s almost impossible where I live to find people with similar interests like mine, so this is probably the only way for me to find people with similar interests” (188-190,P6F) “I love coming here because there are so many truly brilliant people with so much to learn and so many interesting things to hear and see” (105-107,P9M)

Theme 2. How the participant sees their current situation

Although participants were not specifically asked, they took it upon themselves to reflect how they see the current situation and their specific circumstance in terms of being socially isolated. Participants felt that they were socially isolated and less social for several reasons. These have been broken down into the following sub-themes.

Introverted/anti-social

Several participants stated that they are socially inhibited and anxious individuals, who find socialising in the real world more challenging, whereas social VR offers a less intimidating way for them to meet and make friends.

“If you struggle with social interaction, VR is a little less intimidating, I would say. I really think these platforms are a great way to connect and less intimidating as well” (240-245,P3F) “Prior to Covid I was actually pretty like unsocial, I still kind of am unsocial, but it seems as though now society is kind of like bending towards introverts so in a sense it’s like the market’s benefiting my type so like in a sense I’m becoming increasingly more social” (18-22,P2M).

Socially isolated due to remote location and work/life balance

Some participants lamented that their geographic location or work/life balance in the real world made it very difficult for them to meet and to have frequent interactions with people with similar interests to theirs. This aspect makes them at a greater risk of loneliness to others. Social interaction within social VR is not restricted by geographic location and so these participants feel that this has helped to enhance their social interaction with others.

“I use VR to socialise because I live in a little village so for me it’s the only way to meet people, to communicate with people etc because normally I don’t meet people in the real life. With my friends and with my brother etc so I use the VR to socialise okay” (40-43,P4M) “I went on sabbatical in September this academic year I spent my entire summer, last year outside hiking and camping and all of that and then all of a sudden I was inside doing research and I was isolated from my community. I feel like my work community is my community, you know, and I felt like I lost my community and I felt like I found a new one in Altspace” (259-265,P1M)

Theme 3. How the participant sees the social VR platform

Several participants elaborated in detail on how they felt that social VR helped them to connect with people in ways that were better than alternative digital communication methods such as video conferencing, text chat or social media.

Greater immersion/presence

Immersion and presence are important characteristics within VR because the aim after all is to replicate, to some degree, the feelings of being within the real world. The more this is made possible the more useful VR will be in combating feelings of loneliness and social anxiety during periods of prolonged isolation in the real world.

“I’ve been in here with students for tutorials and […] students have said that they feel more presence with other students in this environment” (108-111,P9M) “I’m a perceptual psychologist so I even think about it from the view of like it feels like some of the spaces that I go into now in Altspace really regularly feel in my head like real spaces that I go to so when I feel like I go to a couple of events in the afternoon in Altspace and then I take the headset off it kind of feels like I left my house and I went out and did something and then came back, it doesn’t feel like I was in my house the whole time” (154-160,P1M)

More ways to connect

In addition to the greater immersion and presence that VR can create, Altspace VR also gives individuals the ability to control and create their own environments for social interaction. It is not possible within the real world for most of us to simply create our own hang-outs or to control our environments so easily. This allows people to therefore interact in ways that up until now have not been possible. Several participants linked the ability to create stimulating and exciting environments in the Altspace VR to something that they can feel proud of, and this gives them social capital over other users with less advanced skills in world creation. This in turn helps to improve their ability to socialise and build further friendships in social VR that they would not have been able to build in the real world.

“I made a beach environment, a beach world and there are other ones out there, but I made a custom private one for me and my friends to meet in and so we meet in there and other places and we bounce around and look at different places but we often find somewhere like a private room where we can actually have a nice private conversation and we don’t have to worry about anyone interfering and everyone said its fantastic it really allows us to connect in ways, you know like those personal chats you have with close friends that it’s hard to do in any other medium, it feels a little more natural in VR to do that and so it’s been fantastic, we’ve been really enjoying it” (132-142,P1M) “Since coming in here now [my friends] are like world building and have created some really awesome spaces in here and so we go in and check out the space that they just created and so I’m still kind of doing project oriented hang-outs as far as like we will be like oh that lighting needs to be a little different and stuff like that but it’s been a really fun way to hang out with people that I already may have been friends with before all this happened but now that this happened they are starting to come into this space so we can connect even more often” (214-222,P5F)

Theme 4. How social VR is helping during the Covid-19 pandemic

In the second part of the focus group, participants were asked to think about how they thought Altspace VR was helping them specifically during the Covid-19 pandemic and whether they thought that others could benefit from this experience too. The responses were very positive and provided a great deal of insight into how Altspace VR is helping them to deal with loneliness and social anxiety during Covid-19. A number of key sub-themes emerged from this category.

Helps people feel less lonely

Several participants said that social VR helps them to feel connected with a circle of friends and that this helps to reduce feelings of loneliness and depression.

“I feel it really does help me in social isolation. I have been on sabbatical this last year so my whole year has been about isolation even before Covid-19, I’ve been working a lot on my own and that sort of thing so yeah becoming part of the community in Altspace, collectively in the different ways that I have has had a huge impact on my mental health. I was getting a little depressed in the fall and having this community has really felt like that it brought me out of it a bit” (147-154,P1M) “By the second semester I only had like one course and we were like really concentrating on a specific project and everything and it was like really limiting me to go outside and do some other stuff. Even though I’m an introvert but I do feel like I really wanted to go outside and have some fun. I really like to see other stuff around me and doing all this stuff here in VR kept me really engaged with the communities” (191-197,P8M)

Helps to motivate and provide structure

Having a purpose and being occupied with an interesting project and subsequently conversing about its progress/issues with others in social VR were perceived as motivational factors, which helped them to deal with the imposed social isolation.

“Events really motivated me to keep busy also when I was in social isolation for two months. Yeah, two months is a long time you know to not get out of your house so that was great I created some sense of purpose and it was really heart-warming to see everybody come together and really interesting people as well. Everybody has something cool to share and was very helpful so that gave me some energy, you know to just keep on going and make the best out of the situation” (166-173,P3F) “I finally have a structure for a project that I have been thinking about for over a year now and having these interactions in here and talking to people allowed me to bring a clear picture of how I can start a project I have been thinking about and start building it inside Altspace, so that’s a big plus for me” (178-182,P6F)

Helps people to be less anti-social and reduced social anxiety

Several participants explained that social VR is “a great way to connect and less intimidating as well” for socially anxious, i.e. “unsocial” and “introverted” people, who as a result often feel lonely. In addition, social VR is a convenient tool for social interactions as it brings people closer “especially during these situations, but not only during like pandemics”. (240–243,P3F)

“In my case the Covid increased my social interaction with people because I’m a pretty anti-social person in real life so for me this has increased ten-fold my social interaction in general” (174-176,P6F). “Covid pushed people inside spaces like VR and made my social interactions far easier to have” (186-188,P6F). “I am in sort of a group, let’s say of people who have problems with connecting with people, this is awesome. This is definitely a big plus and I would like more of this” (322-324,P6F) “I was, I guess, somewhat socially isolated before coming in Altspace I tend to just like to work on projects and stay at home or be at work, but since coming in Altspace I’ve definitely started experiencing more of the social aspect of living like making connections with other people in ways that aren’t strictly like a project that I’m working on and so that’s been nice” (202-208,P5F). “I do think that VR can help us, those of us who are socially isolated or have social anxieties of some sort. It does make it more accessible for us to be able to go into a space and interact with people. For instance in real life, if you were to have social anxiety and you start feeling almost like a panic attack coming on, that would prevent you from going into a real life space, whereas in VR you […] can say, oh I have to go really easily and you’re back in your home and you can work through whatever may have come up with social anxiety. So I do think it makes social interactions more accessible in those cases” (307-316,P5F)

Helps to socialise with real life friends during lock-down

Another idea that surfaced among the participants is the potential to use social VR as a mode of interaction/engagement with real-life friends/family members who live afar. Participants expressed the view that the current restriction on face-to-face contact could to some extent be counterbalanced by inviting real-world friends into social VR to socialise.

“The fully social part of VR has happened because of the Covid-19 situation, because I used to go for dinners with people like every month, […] and we can’t do the real world social, so we are trying to do the VR social” (142-146,P1M) “Once everyone went into social isolation for Covid I actually started hanging out with a friend that lives 3 hours away from me more than before because before it would be a 3 hour drive, but then once all this happened, I actually convinced them to come into Altspace” (208-212,P5F) “It’s been a really fun way to hang out with people that I already may have been friends with before all this happened but now that this happened they are starting to come into this space so we can connect even more often. (218-222,P5F).

Discussion of qualitative findings

Overall, participants’ commentaries to Theme 1 reconfirm that their usage of social VR has increased during the period of imposed social isolation and restrictions on physical meetups due to the Covid-19 pandemic. They were using social VR to meet with real-world friends to satisfy their social needs and continue to receive support from people they are close to; or to mix socially with other users who they meet either at a “campfire” or whilst taking part in regular events inside of the social VR platform, thus expanding their social network of non-intimate contacts. As a result, they felt less lonely online (whilst being in Altspace VR) as they felt like they were in the same space together. Interestingly, participants noted that they also benefited emotionally from meeting like-minded people/professionals and sharing ideas with them, getting support and advice, and working together in real-time. This is a new explanation why people use VR technology, which did not surface in the earlier research studies. Nonetheless this reason ties with the Need to Belong Theory 47 . This is useful to help us to understand why users visit Altspace VR in general and during the enforced social isolation period.

In theme 2 participants’ responses reiterate what has already been explained in the literature that shy, socially inhibited and anxious individuals find online anonymity liberating and less inhibited than the real world 52 . Moreover, in Altspace VR it is also possible to make use of non-verbal communication such as emojis or emoticons (see Fig.  6 ).

Use of emojis to communicate in Altspace VR.

Some participants commented that their geographic location or work/life balance in the real world made it very difficult for them to meet people with similar interests. The social internet, e.g. Facebook 53 and video conferencing 54 have long been used to socialise with friends and family and have been found to be an affective intervention for reducing loneliness. Theme 3 considers that social VR could be regarded as the latest endeavour within this field as individuals are able to create their own exciting hangouts, e.g. a beach or a city from Ancient Greece. Furthermore users are able to easily control environments and restrict entry. This allows people to interact in ways that up until now have not been possible.

Findings in Theme 4 give a clear indication that social VR helps to reduce feelings of loneliness, and this further supports the findings of 32 . Social interactions in social VR are also particularly attractive to those who are lonely or shy/socially anxious/self-conscious or have poor social skills, etc. as they feel more in control of their online interactions and feel that they have a broader range of topics that they are able to discuss compared with in the real world 55 . Lonelier people also feel that they can be more themselves in online social interactions than in the real world 56 .

General discussion

People use social VR for many different reasons: to socialise with new and existing friends; to join social interest groups; to learn new skills and generally to be part of a larger community of people (including other professionals) than those that they are part of in the real world. Social VR attracts a wide range of people because of the ease in which people can meet people with similar interests to their own, although it could be argued that up until the recent Covid-19 pandemic social VR tended to attract a greater amount of people who found real-life social interaction difficult. The results of this study show a reduction in social anxiety in individuals with moderate, severe and very severe social anxiety in the online condition, i.e. when using social VR. The increase in availability of VR headsets in recent years has led to an expansion in usage of social VR and the recent Covid-19 pandemic and subsequent social distancing rules led to more people and organisations making a greater use of VR to communicate and carry out their daily business and routines during the prolonged period of social isolation. Social VR also enables people to collaborate in ways not possible within the real world, reducing geographic restrictions and breaking through communication barriers by using visually stimulating content creation tools to enhance the process of human interaction through world-building and event hosting.

The main objective of this study was to explore whether social VR could be used to help reduce feelings of loneliness and social anxiety amongst people confined to their homes and away from their regular friendship groups and social connections, i.e. when the quantity and quality of their social network is gravely affected. Overall, the synthesised results of the present study show that participants experience a statistically significant reduction in loneliness and social anxiety when in social VR than in the real world during prolonged periods of imposed social isolation. Qualitative findings support/validate the quantitative results for H1. Thus, the evidence shows that social VR can decrease the sense of loneliness and social anxiety with users and have an overall positive effect on their emotional and social wellbeing.

The qualitative data diverges from the quantitative results presented for H2 that addressed the effect of being part of a VSG separately for loneliness and social anxiety. The quantitative results showed no significant effect for loneliness in the online and the offline conditions, whereas participants’ views showed that being a member of a VSG created a sense of belongingness and helped them to feel less lonely and depressed. Quantitative data showed no significant effect for social anxiety when an individual is a member of a VSG or not; but revealed a medium effect for social anxiety in the offline condition indicating that users, who are part of a VSG and subsequently take part in regular group events, experience less social anxiety in real world (i.e. offline), than those who are not part of a VSG. Participants who are part of a VSG were positive about the possibilities of social VR and being part of a VSG, because this setup helped shy and socially inhibited individuals to observe conversations, use emojis to show emotions rather than speak, use the online anonymity to get over the discomfort of social interactions and gradually become more connected and accepted by other members of the VSG. This prepares socially anxious individuals to handle being out there (in online and the real world).

Qualitative findings are in line with the quantitative results for H3 in that the degree of loneliness and social anxiety is also further reduced by factors such as having a circle of online friends. Social VR allows people to meet others who share similar interests, this is more difficult within the real world for people who struggle with social anxiety or who live in remote locations for example, or as was the case with this study, people who were confined to their homes due to social distancing rules during a pandemic. The qualitative data helps to produce a better understanding in relation to ‘online friends’ as these include individuals who were met in social VR and real-life friends who currently live afar and were invited to join the social VR platform.

The qualitative findings somewhat converge with quantitative results for H4 in that online loneliness reduces with the length of time the participant has been using social VR, i.e. participants who had been using social VR for greater than 6 months experienced less loneliness than those who joined during the Covid-19 pandemic. The length of time the participant had been using social VR had no effect on their feelings of loneliness in the real world. Comments from participants who have been members of Altspace VR for more than 6 months revealed that finding a new (online) community that supports their need to belong and provides meaningful and positive social interactions acted as an antidote to the loneliness that they experience in the real world. Individuals who struggle to build meaningful relationships in the real world due to social anxiety and other social phobias turn to social VR as it provides a less confrontational way in which to form and maintain social relationships with others and therefore help to reduce feelings of loneliness and social anxiety.

Research limitations and implications

The heterogeneity of the sample for the quantitative survey enabled conclusions to be drawn regarding the participant experience in Altspace VR, their subjective feelings of loneliness and social during the Covid-19 pandemic. However, in interpreting the views of participants in the focus group it should be stressed that the sample of participants was solely recruited from the Educators in VR research event and that this may not represent the views of others who do not take part in such events. Although the reported themes were clearly identified, there remains a possibility that additional themes would be detected should the views of participants from a wider pool be collected.

It is the researcher’s understanding that this is the first study that has exclusively focused on participant’s feelings of loneliness and social anxiety during a period of enforced prolonged isolation whereby social VR has been utilized as an intervention to help reduce such feelings. The results offered here, should therefore be taken as a starting point upon which further empirical studies could be built. Longitudinal investigations could be carried out to further assess the suitability of social VR as an intervention to help reduce loneliness and social anxiety amongst specific communities, e.g. remote learners/workers, people living alone or in care, the less physically able, prisoners and other sub-groups of people facing loneliness and social anxiety whereby their ability to socialise with other is in some way restricted. Future research would also need to provide accurate estimates of the prevalence of loneliness and social anxiety in these sub-groups.

The COVID-19 pandemic forced people to change the way in which they connected with others during lockdown. Social VR helped to improve social connectedness during the COVID-19 pandemic and reduce “lockdown loneliness”. Post-pandemic it is necessary to recognise the additional needs that face society, especially vulnerable people and those struggling with mental health issues resulting from lockdown. Social VR can, therefore, be a way of further supporting people facing social isolation, loneliness and social anxiety. Social VR platforms may be virtual, but the relationships we build in them are very real.

Data availability

All data generated or analysed during this study are included in this published article or in the accompanying Supplementary Information file.

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Kenyon, K., Kinakh, V. & Harrison, J. Social virtual reality helps to reduce feelings of loneliness and social anxiety during the Covid-19 pandemic. Sci Rep 13 , 19282 (2023). https://doi.org/10.1038/s41598-023-46494-1

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Guest Essay

The Happiness Gap Between Left and Right Isn’t Closing

By Thomas B. Edsall

Mr. Edsall contributes a weekly column from Washington, D.C., on politics, demographics and inequality.

Why is it that a substantial body of social science research finds that conservatives are happier than liberals?

A partial answer: Those on the right are less likely to be angered or upset by social and economic inequities, believing that the system rewards those who work hard, that hierarchies are part of the natural order of things and that market outcomes are fundamentally fair.

Those on the left stand in opposition to each of these assessments of the social order, prompting frustration and discontent with the world around them.

The happiness gap has been with us for at least 50 years, and most research seeking to explain it has focused on conservatives. More recently, however, psychologists and other social scientists have begun to dig deeper into the underpinnings of liberal discontent — not only unhappiness but also depression and other measures of dissatisfaction.

One of the findings emerging from this research is that the decline in happiness and in a sense of agency is concentrated among those on the left who stress matters of identity, social justice and the oppression of marginalized groups.

There is, in addition, a parallel phenomenon taking place on the right as Donald Trump and his MAGA loyalists angrily complain of oppression by liberals who engage in a relentless vendetta to keep Trump out of the White House.

There is a difference in the way the left and right react to frustration and grievance. Instead of despair, the contemporary right has responded with mounting anger, rejecting democratic institutions and norms.

In a 2021 Vox article, “ Trump and the Republican Revolt Against Democracy ,” Zack Beauchamp described in detail the emergence of destructive and aggressive discontent among conservatives.

Citing a wide range of polling data and academic studies, Beauchamp found:

More than twice as many Republicans (39 percent) as Democrats (17 percent) believed that “if elected leaders won’t protect America, the people must act — even if that means violence.”

Fifty-seven percent of Republicans considered Democrats to be “enemies,” compared with 41 percent of Democrats who viewed Republicans as “enemies.”

Among Republicans, support for “the use of force to defend our way of life,” as well as for the belief that “strong leaders bend rules” and that “sometimes you have to take the law in your own hands,” grows stronger in direct correlation with racial and ethnic hostility.

Trump has repeatedly warned of the potential for political violence. In January he predicted bedlam if the criminal charges filed in federal and state courts against him damaged his presidential campaign:

I think they feel this is the way they’re going to try and win, and that’s not the way it goes. It’ll be bedlam in the country. It’s a very bad thing. It’s a very bad precedent. As we said, it’s the opening of a Pandora’s box.

Before he was indicted in New York, Trump claimed there would be “potential death and destruction” if he was charged.

At an Ohio campaign rally in March, Trump declared, “If I don’t get elected, it’s going to be a blood bath for the whole country.”

In other words, Trump and his allies respond to adversity and what they see as attacks from the left with threats and anger, while a segment of the left often but not always responds to adversity and social inequity with dejection and sorrow.

There are significant consequences for this internalization.

Jamin Halberstadt , a professor of psychology at the University of Otago in New Zealand and a co-author of “ Outgroup Threat and the Emergence of Cohesive Groups : A Cross-Cultural Examination,” argued in his emailed reply to my inquiry that because “a focus on injustice and victimhood is, by definition, disempowering (isn’t that why we talk of ‘survivors’ rather than ‘victims’?), loss of control is not good for self-esteem or happiness.”

But, he pointed out:

this focus, while no doubt a part of the most visible and influential side of progressive ideology, is still just a part. Liberalism is a big construct, and I’m reluctant to reduce it to a focus on social justice issues. Some liberals have this view, but I suspect their influence is outsized because (a) they have the social media megaphone and (b) we are in a climate in which freedom of expression and, in particular, challenges to the worldview you characterize have been curtailed.

Expanding on this line of argument, Halberstadt wrote:

I’m sure some self-described liberals have views that are counterproductive to their own happiness. One sub-ideology associated with liberalism is, as you describe, a sense of victimhood and grievance. But there is more than one way to respond to structural barriers. Within that group of the aggrieved, some probably see systemic problems that cannot be overcome, and that’s naturally demoralizing and depressing. But others see systemic problems as a challenge to overcome.

Taking Halberstadt’s assessment of the effects of grievance and victimhood a step farther, Timothy A. Judge , the chairman of the department of management and human resources at Notre Dame, wrote in a 2009 paper, “ Core Self-Evaluations and Work Success ”:

Core self-evaluations (C.S.E.) is a broad, integrative trait indicated by self-esteem, locus of control, generalized self-efficacy and (low) neuroticism (high emotional stability). Individuals with high levels of C.S.E. perform better on their jobs, are more successful in their careers, are more satisfied with their jobs and lives, report lower levels of stress and conflict, cope more effectively with setbacks and better capitalize on advantages and opportunities.

I asked Judge and other scholars a question: Have liberal pessimists fostered an outlook that spawns unhappiness as its adherents believe they face seemingly insurmountable structural barriers?

Judge replied by email:

I do share the perspective that a focus on status, hierarchies and institutions that reinforce privilege contributes to an external locus of control. And the reason is fairly straightforward. We can only change these things through collective and, often, policy initiatives — which tend to be complex, slow, often conflictual and outside our individual control. On the other hand, if I view “life’s chances” (Virginia Woolf’s term) to be mostly dependent on my own agency, this reflects an internal focus, which will often depend on enacting initiatives largely within my control.

Judge elaborated on his argument:

If our predominant focus in how we view the world is social inequities, status hierarchies, societal unfairness conferred by privilege, then everyone would agree that these things are not easy to fix, which means, in a sense, we must accept some unhappy premises: Life isn’t fair; outcomes are outside my control, often at the hands of bad, powerful actors; social change depends on collective action that may be conflictual; an individual may have limited power to control their own destiny, etc. These are not happy thoughts because they cause me to view the world as inherently unfair, oppressive, conflictual, etc. It may or may not be right, but I would argue that these are in fact viewpoints of how we view the world, and our place in it, that would undermine our happiness.

Last year, George Yancey , a professor of sociology at Baylor University, published “ Identity Politics, Political Ideology, and Well-Being : Is Identity Politics Good for Our Well-Being?”

Yancey argued that recent events “suggest that identity politics may correlate to a decrease in well-being, particularly among young progressives, and offer an explanation tied to internal elements within political progressiveness.”

By focusing on “political progressives, rather than political conservatives,” Yancey wrote, “a nuanced approach to understanding the relationship between political ideology and well-being begins to emerge.”

Identity politics, he continued, focuses “on external institutional forces that one cannot immediately alleviate.” It results in what scholars call the externalization of one’s locus of control, or viewing the inequities of society as a result of powerful if not insurmountable outside forces, including structural racism, patriarchy and capitalism, as opposed to believing that individuals can overcome such obstacles through hard work and collective effort.

As a result, Yancey wrote, “identity politics may be an important mechanism by which progressive political ideology can lead to lower levels of well-being.”

Conversely, Yancey pointed out, “a class-based progressive cognitive emphasis may focus less on the group identity, generating less of a need to rely on emotional narratives and dichotomous thinking and may be less likely to be detrimental to the well-being of a political progressive.”

Yancey tested this theory using data collected in the 2021 Baylor Religion Survey of 1,232 respondents.

“Certain types of political progressive ideology can have contrasting effects on well-being,” Yancey wrote. “It is plausible that identity politics may explain the recent increase well-being gap between conservatives and progressives.”

Oskari Lahtinen , a senior researcher in psychology at the University of Turku in Finland, published a study in March, “ Construction and Validation of a Scale for Assessing Critical Social Justice Attitudes ,” that reinforces Yancey’s argument.

Lahtinen conducted two surveys of a total of 5,878 men and women to determine the share of Finnish citizens who held “critical social justice attitudes” and how those who held such views differed from those who did not.

Critical social justice proponents, on Lahtinen’s scale,

point out varieties of oppression that cause privileged people (e.g., male, white, heterosexual, cisgender) to benefit over marginalized people (e.g., woman, Black, gay, transgender). In critical race theory, some of the core tenets include that (1) white supremacy and racism are omnipresent and colorblind policies are not enough to tackle them, (2) people of color have their own unique standpoint and (3) races are social constructs.

What did Lahtinen find?

The critical social justice propositions encountered

strong rejection from men. Women expressed more than twice as much support for the propositions. In both studies, critical social justice was correlated modestly with depression, anxiety, and (lack of) happiness, but not more so than being on the political left was.

In an email responding to my inquiries about his paper, Lahtinen wrote that one of the key findings in his research was that “there were large differences between genders in critical social justice advocacy: Three out of five women but only one out of seven men expressed support for the critical social justice claims.”

In addition, he pointed out, “there was one variable in the study that closely corresponded to external locus of control: ‘Other people or structures are more responsible for my well-being than I myself am.’”

The correlation between agreement with this statement and unhappiness was among the strongest in the survey:

People on the left endorsed this item (around 2 on a scale of 0 to 4) far more than people on the right (around 0.5). Endorsing the belief was determined by political party preference much more than by gender, for instance.

Such measures as locus of control, self-esteem, a belief in personal agency and optimism all play major roles in daily life.

In a December 2022 paper, “ The Politics of Depression : Diverging Trends in Internalizing Symptoms Among U.S. Adolescents by Political Beliefs,” Catherine Gimbrone , Lisa M. Bates , Seth Prins and Katherine M. Keyes , all at Columbia’s Mailman School of Public Health, noted that “trends in adolescent internalizing symptoms diverged by political beliefs, sex and parental education over time, with female liberal adolescents experiencing the largest increases in depressive symptoms, especially in the context of demographic risk factors, including parental education.”

“These findings,” they added, “indicate a growing mental health disparity between adolescents who identify with certain political beliefs. It is therefore possible that the ideological lenses through which adolescents view the political climate differentially affect their mental well-being.”

Gimbrone and her co-authors based their work on studies of 85,000 teenagers from 2005 to 2018. They found that

while internalizing symptom scores worsened over time for all adolescents, they deteriorated most quickly for female liberal adolescents. Beginning in approximately 2010 and continuing through 2018, female liberal adolescents reported the largest changes in depressive affect, self-esteem, self-derogation and loneliness.

In conclusion, the authors wrote, “socially underprivileged liberals reported the worst internalizing symptom scores over time, likely indicating that the experiences and beliefs that inform a liberal political identity are ultimately less protective against poor mental health than those that inform a conservative political identity.”

From another vantage point, Nick Haslam , a professor of psychology at the University of Melbourne, argued in his 2020 paper “ Harm Inflation: Making Sense of Concept Creep ” that recent years have seen “a rising sensitivity to harm within at least some Western cultures, such that previously innocuous or unremarked phenomena were increasingly identified as harmful and that this rising sensitivity reflected a politically liberal moral agenda.”

As examples, Haslam wrote that the definition of “trauma” has been

progressively broadened to include adverse life events of decreasing severity and those experienced vicariously rather than directly. “Mental disorder” came to include a wider range of conditions, so that new forms of psychopathology were added in each revision of diagnostic manuals and the threshold for diagnosing some existing forms was lowered. “Abuse” extended from physical acts to verbal and emotional slights and incorporated forms of passive neglect in addition to active aggression.

Haslam described this process as concept creep and argued that “some examples of concept creep are surely the work of deliberate actors who might be called expansion entrepreneurs.”

Concept expansion, Haslam wrote, “can be used as a tactic to amplify the perceived seriousness of a movement’s chosen social problem.” In addition, “such expansion can be effective means of enhancing the perceived seriousness of a social problem or threat by increasing the perceived prevalence of both ‘victims’ and ‘perpetrators.’”

Haslam cited studies showing that strong “correlates of holding expansive concepts of harm were compassion-related trait values, left-liberal political attitudes and forms of morality associated with both.” Holding expansive concepts of harm was also “associated with affective and cognitive empathy orientation and most strongly of all with endorsement of harm- and fairness-based morality.” Many of these characteristics are associated with the political left.

“The expansion of harm-related concepts has implications for acceptable self-expression and free speech,” Haslam wrote. “Creeping concepts enlarge the range of expressions judged to be unacceptably harmful, thereby increasing calls for speech restrictions. Expansion of the harm-related concepts of hate and hate speech exemplifies this possibility.”

While much of the commentary on the progressive left has been critical, Haslam takes a more ambivalent position: “Sometimes concept creep is presented in an exclusively negative frame,” he wrote, but that fails to address the “positive implications. To that end, we offer three positive consequences of the phenomenon.”

The first is that expansionary definitions of harm “can be useful in drawing attention to harms previously overlooked. Consider the vertical expansion of abuse to include emotional abuse.”

Second, “concept creep can prevent harmful practices by modifying social norms.” For example, “changing definitions of bullying that include social exclusion and antagonistic acts expressed horizontally rather than only downward in organizational hierarchies may also entrench norms against the commission of destructive behavior.”

And finally:

The expansion of psychology’s negative concepts can motivate interventions aimed at preventing or reducing the harms associated with the newly categorized behaviors. For instance, the conceptual expansion of addiction to include behavioral addictions (e.g., gambling and internet addictions) has prompted a flurry of research into treatment options, which has found that a range of psychosocial treatments can be successfully used to treat gambling, internet and sexual addictions.

Judge suggested an approach to this line of inquiry that he believed might offer a way for liberalism to regain its footing:

I would like to think that there is a version of modern progressivism that accepts many of the premises of the problem and causes of inequality but does so in a way that also celebrates the power of individualism, of consensus and of common cause. I know this is perhaps naïve. But if we give in to cynicism (that consensus can’t be found), that’s self-reinforcing, isn’t it? I think about the progress on how society now views sexual orientation and the success stories. The change was too slow, painful for many, but was there any other way?

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Thomas B. Edsall has been a contributor to the Times Opinion section since 2011. His column on strategic and demographic trends in American politics appears every Wednesday. He previously covered politics for The Washington Post. @ edsall