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HEALTH PSYCHOLOGY

ASSESSMENT AND TREATMENT ANXIETY DISORDER AMONG


TEENAGERS AT UNIVERSITY

Nurafifah Natrah Binti Ahmad Nahar

University of Selangor
ASSESSMENT AND TREATMENT ANXIETY DISORDER AMONG TEENAGERS AT UNIVERSITY

TABLE OF CONTENTS

CHAPTER ONE: INTRODUCTION .................................................................................... 1

1.0 INTRODUCTION ....................................................................................................... 1

1.1 BACKGROUND ......................................................................................................... 1

1.2 DESCRIPTION OF SOCIAL ANXIETY DISORDER.............................................. 2

1.3 INCIDENCES OF SOCIAL ANXIETY DISORDER ................................................ 3

1.4 RELEVANCE AND IMPORTANCE TO TEENAGERS .......................................... 4

1.5 STATEMENT OF PURPOSE .................................................................................... 5

1.6 RESEARCH AIMS ..................................................................................................... 6

1.7 RESEARCH QUESTIONS ......................................................................................... 6

1.8 DEFINITION OF KEY TERMS................................................................................. 7

1.8.1 Anxiety Disorder .................................................................................................. 7

1.8.2 Assessment ........................................................................................................... 7

1.8.3 Treatment ............................................................................................................. 8

1.9 RATIONALE .............................................................................................................. 8

CHAPTER TWO: LITERATURE REVIEW ..................................................................... 10

2.0 INTRODUCTION ..................................................................................................... 10

2.1 CAUSES OF ANXIETY DISORDER ON TEENAGERS .................................... 10

2.2 EFFECTS OF ANXIETY DISORDER AMONG TEENAGERS ............................ 11

2.3 CLINICAL SYMPTOMS OF ANXIETY DISORDER .......................................... 11

2.4 ASSESSMENT OF ANXIETY DISORDER ........................................................... 13

2.5 TREATMENT OF ANXIETY DISORDER ............................................................. 18

REFERENCES ....................................................................................................................... 22

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CHAPTER ONE: INTRODUCTION

1.0 INTRODUCTION

This study was designed to determine the practices exist to assessment and

treatment of anxiety disorder among teenagers at university. Besides that, this study

also to generate the best practices for both assessment and treatment. To complete

these research aim, this chapter will discussed background of study, a descriptions of

anxiety disorder, its incidences and important for teenagers. Meanwhile, statements of

purpose, research aims and research questions, terms and the rationale also include in

this discussion.

1.1 BACKGROUND

Anxiety disorder is the crucial problem can affects the teenagers. According to

(Mohammad, 2016), the fear of embarrassment over any matter could push students

towards extreme consternation. Moreover, from the observed views personal life and

family history was the recorded from interaction with the teenagers (M.Wehry et.al,

2015).

Personal life and family history as well as can affects social skills deficit

(Cartwright-Hatton, Tschernitz & Gomersall, 2003), academic performance (Vitasari

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ASSESSMENT AND TREATMENT ANXIETY DISORDER AMONG TEENAGERS AT UNIVERSITY

et.al, 2010), physical and mental health (K. Shamsudin et.al, 2013) and their school

environment and life (M.Wehry et.al, 2015).

Worry and alone one of symptoms anxiety disorders among Malaysian

university students (Mohammad, 2016). The psychometric test assessments and

psychological treatments is the therapy available for social anxiety disorder but there

is not much information to measure this research.

Understanding existence assessment and treatment is an extremely important

to conducting the assessment and treatments for anxiety patients with systematic and

professionally. Meanwhile, it can control level of patient anxiety with better and

comprehensive assessment and treatment technique.

1.2 DESCRIPTION OF ANXIETY DISORDER

Anxiety disorder can describe the dual characteristics of excessive emotional

fear and physiologic hyper arousals (Breuer, 1999). The Psychophysiology is one of

the anxiety difficulties (Callahan, 2001). Shy and phobia is some of the suffer

experience for anxiety disorder. An individual have anxiety includes excessive

worrying, a sense of fear restlessness, overly emotional responses and negative

thinking (Vitasari et.al, 2010).

According to Harris and Coy (2003) mentioned anxiety is the basic human

emotion consisting of apprehension and uncertainty that typically appears when an

individual perceives an occurrence as being a threat to the ego or self-esteem. From

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this concept, individual have high level of anxiety directly hold heightened trait, but

in evaluative situation can state of anxiety and elevates (Vitasari et.al, 2010).

Therefore, social anxiety disorder refers to conditions that are bad experienced

happen to an individual that involves two dimension includes physiological arousal

and cognitive anxiety.

1.3 INCIDENCES OF ANXIETY DISORDER

Malaysian student reported 63% high level of anxiety causes of socio-

demographic problem that is low family income, marital status, living arrangement,

and lonely then affects their emotion more too worried and stress (K.Shamsuddin

et.al, 2013). Bayram and Bilgel, (2008) mentioned the prevalence of anxiety among

university student is 47%. According to Nolan and Walters (2000), female students

high risk to affects anxiety because easily feel a fear and negative thinking.

Vitasari et.al, (2010) reported every year engineering students given low

academic performance because of high level of anxiety. In addition, there also

recorded female students have high score with 53.2% while male students score

46.8%. Shy and phobia is one reason of students have anxiety disorder, there feel a

fear with their social exchange (Olivares, García and Pina, 2009). There is listed the

symptoms of social anxiety disorder are:

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Table 1 : Symptoms of Social Anxiety Disorder

No. Symptoms

1. Hesitance, passivity, and discomfort in the spotlight.

2. Avoiding or refusing to initiate conversations, invite

friends to get together, order food in restaurants, or call, text, or e-mail peers

3. Frequently avoiding eye contact with adults or peers.

4. Speaking very softly or mumbling.

5. Appearing isolated or on the fringes of the group.

6. Sitting alone.

7. Overly concerned with negative evaluation, humiliation, or embarrassment.

8. Difficulty with public speaking, reading aloud, or being called on in class.

Source: Anxiety Disorders Association of America (2016)

1.4 RELEVANCE AND IMPORTANCE TO TEENAGERS

The systematic appraisal collected basic data relevant to the syndrome and it

also finding and analyzing the reliable methodology for the assessment and treatment

of anxiety disorder. It includes the best practices to managing control level of anxiety

to teenagers. After that, also provides the guidelines and procedures to conduct

assessment and treatment.

In addition, systematic appraisal can help in the development of strategies to

counter the potentially anxiety feeling consequences of life problems. Thus,

development the current issues of assessment and treatment with rightness. It also can

help the teenagers to increase their knowledges about anxiety disorder.

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1.5 STATEMENT OF PURPOSE

Assessment and treatment must to conduct in this systematic appraisal. But,

this research lack of information about assessment and treatment. Many recent studies

would interest to conducted assessment and treatment of anxiety disorder focus on

children not the teenagers. From the objective, lack of tools gathered to examines the

assessment and treatment.

Adopt the valid and reliable assessment and treatment is too important when

conducted this research. Screening and assessment tools have been developed to assist

clinicians in identifying anxiety symptoms early and accurately establishing anxiety

disorder diagnoses (M.Wehry et.al, 2015). Therefore, this research would to the best

practices assessment to reduce anxiety disorder among teenagers.

Treatment means avoidance, recovery and minimization consequences of

disease. This study aims to searching the good treatment to anxiety disorder for

teenagers. However, recent studies have a limited meditations technique to anxiety

disorder treatments (Kabat-Zinn, et al., 1992). Actually, both the assessment and

treatment have negative and positive outcome to recovery disorder. So, hopefully this

research potential can develop good strategies to recovery the assessment and

treatment.

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1.6 RESEARCH AIMS

The aims objectives of this paper were listed as follows:

a) Determine the practices exist to assessment of anxiety disorder among

teenagers at university.

b) Determine the practices exist to treatment of anxiety disorder among teenagers

at university.

c) Generate the best practices for both assessment and treatment of anxiety

disorder among teenagers at university.

The first aim involves determining the practices available to conduct the

assessment. Many psychometric tests can be too discussed in this situation. Secondly,

the research aim is strategies that can used to manage anxiety treatment to teenagers.

Lastly, the aim focuses to generate the best practices assessment and treatment good

to developed for teenagers.

1.7 RESEARCH QUESTIONS

The following research questions were formulated for the study:

a) What are practices exist to assessment of anxiety disorder?

b) What are practices exist to treatment of anxiety disorder?

c) What are best practices for both assessment and treatment of anxiety disorder?

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1.8 DEFINITION OF KEY TERMS

In this systematic appraisal, there have three keys terms are defined.

Following the below terms listed are:

1.8.1 Anxiety Disorder


Anxiety can defined negative feeling to tension, apprehension,

nervousness and worry with arousal of the nervous system (Spielberger,

1983). People have high level of anxiety can affects their mental illness

(Vitasari et. al, 2010). Anxiety disorders are common, treatable medical

conditions that affect one in eight children (Mohammad, 2016). They are

characterized by persistent, irrational, and overwhelming worry, fear, and

anxiety that interfere with daily activities. These are real disorders that affect

how the brain functions. The term “anxiety disorder” refers to a group of

mental illnesses that includes generalized anxiety disorder (GAD), obsessive-

compulsive disorder (OCD), panic disorder, posttraumatic stress disorder

(PTSD), social anxiety disorder (also called social phobia), and specific

phobias (ADAA, 2016).

1.8.2 Assessment
Assessment is the process of gathering and discussing information

from multiple and diverse sources related with their tasks (Huba & Freed,

2000). It is the process of defining, collecting, analyzing, interpreting, and

using information to an individual mental illness (Allen, 2014). There is a

process to checking an individual level of behaviour abuse the diseases.

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1.8.3 Treatment
Treatment refers to the way to combating of a disease or disorder (The

Medical Dictonary, 2003). In order, treatment is the tools to an individual

recovery cure pain, illness or sufferings. It includes the strategies meditation

care to patient improvement their conditions (M.Wehry et.al, 2015). The

systematic methods to recovery patient when sufferings by anxiety patients (

Olivares, García, & Pina, 2009).

1.9 RATIONALE

Anxiety is a natural emotion, signaling through stirrings of worry, fearfulness,

and alarm that danger or a sudden, threatening change is near. Yet, sometimes anxiety

becomes an exaggerated, unhealthy response. The student high level anxiety also

predicts that has low ability to study (Vitasari et.al, 2010). In other hand, it not new

experienced teenagers abuse anxiety in university (Nolan and Walters, 2000).

Management rarely conducted any events or program in strategy to students

reduces their emotion during exanimation (Vitasari et.al, 2010). Many students cannot

control their anxiety when faced the problem. As well as, when conducted program,

they know basic concept to control their anxiety symptoms (Mohammad, 2016) such

as shy, worried, nausea, insomnia and other else.

Besides that, psychometrics has been used in the assessment of anxiety

disorder; there is still a lack to evaluate level of student anxiety performance

(M.Wehry et.al, 2015). It is because the questionnaire distributes cannot measures an

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individual answering with honestly. Observed is the best practices strategy to manage

level of an individual anxiety (Cartwright-Hatton, Tschernitz & Gomersall 2013).

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CHAPTER TWO: LITERATURE REVIEW

2.0 INTRODUCTION

This research will review previous research that had been conducted by

another researcher related to assessment and treatment of anxiety disorder among

teenagers. There have some similar studies in this chapter. This chapter focused to

reviews causes of anxiety, effects of anxiety, and the clinical symptoms of anxiety

disorder. In order, this study also reviews the assessment and treatment to anxiety

disorder among teenagers. All the articles obtained from many database such as

Science Direct, Clinical Psychology journal, Google Scholar, HHs public assess and

other else.

2.1 CAUSES OF ANXIETY DISORDER ON TEENAGERS

According to K. Shamssudin et.al 2013, poor socioeconomic background is

the one of common causes teenagers would have high level of anxiety disorder.

Previous studies found current financial struggles (Eisenberg, Golberstein, Gollust, &

Hefner, 2007), not satisfaction with living environments (Christie, Munro, & Retting,

2002), health status (K. Shamsuddin et. al, 2013), and family history or personal is the

signs causes teenagers influence to anxiety.

Moreover, some people believe anxiety disorders are caused by a combination

of biological and environmental factors, similar to allergies and diabetes (ADAA,

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2016). Though students have anxiety disorder need to control their feeling to

experienced anxiety disorder.

2.2 EFFECTS OF ANXIETY DISORDER AMONG TEENAGERS

The prevalence to stress and depression is the effects of teenagers suffering an

anxiety disorder. It affects poor performance in their academic (Vitasari et.al, 2010),

relationship with family and peers also can affect ( R. Zuelling , et al., 2002), physical

and mental health (K. Shamsudin et.al, 2013), and social activity life also can affects

teenagers when they feeling shy, worried and scary faced with sociality.

Teenagers suffer anxiety disorder need supported from their family, peer and

health psychologist to give new energy to themselves (Mohammad, 2016). The best

therapy care to anxiety patients can give outcome to others faced with these problems.

2.3 CLINICAL SYMPTOMS OF ANXIETY DISORDER

Clinical symptoms of anxiety experienced by college student happed when

students lack of interests in a difficult subject whereas the physiological symptoms

(Vitasari et.al, 2013). The symptoms are sweaty palms, cold nervousness, panic, fast

pace of breathing, racing heartbeat, or an upset stomach (Ruffin, 2005).

Shy and worry during examination is one of example symptoms anxiety

disorder among teenagers (Mohammad, 2016). The students lack of self-motivation

during faced with examination there fear to fail certain difficult subject in the courses

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(Vitasari et.al, 2013). The situation caused students get low academic performance in

their results. Supported to anxiety patients can lead to changes their academic

performance (K. Shamssuddin, 2013). Following the below is the types and symptoms

of anxiety disorder among teenagers:

Type Caused Symptoms


Generalized anxiety Excessive anxiety in Seeks reassurance; avoids
Disorder various domains, such activities when performance
as success, health, or may not be
family, and difficulty perfect; physical
controlling the worry symptoms, such as
headaches; difficulty
concentrating or
sleeping; restlessness
Social anxiety Excessive fear of social Avoids speaking in class,
disorder (or social and performance speaking on the phone,
phobia) situations because of eating in public, using
potential negative public restrooms,
evaluation attending social
gatherings
Separation anxiety Excessive anxiety Refuses to go to lecture,
Disorder regarding separation sleep without caregiver
from attachment nearby, or be alone;
figures, fear of negative has nightmares about
consequence to self or separation; avoids
attachment figure if sleeping away from
separated home
Panic disorder Persistent panic attacks, Avoids places or situations
concern about where panic attacks
additional attacks or have occurred in the
their consequences past, avoids places
(e.g., “losing control” or where escape may be
“going crazy”) difficult

Source: Anxiety Disorders Association of America, (2017), pg. 145

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2.4 ASSESSMENT OF ANXIETY DISORDER

By Cartwright-Hatton, Tschernitz and Gomersall (2003) assumption that

effected children skill deficits in childhood social anxiety. They also suggested that

socially anxious individual merely believe that they have skill deficits. The social

Anxiety Scale for children (SASC-R) by LaGreca & Stone, 1993 instruments used in

this study for assess social anxiety symptoms in children aged 9-12 years. The

researchers conclude therapists should be wary of assuming that socially anxious

children are lacking in basic social skills.

According to Vitasari et.al (2010) assessed observed the relationship between

study anxiety level and students performance. The method used Spielherger State

Trait Anxiety Inventory Scale 1993 (STAI). The STAI is documented of reliability

and validity test which is 0.923. Students who have higher score in anxiety achieve

low ability to study. However, it was suggested large of sample size to strengthen the

results.

J. Ingles et.al (2010) on other hand, self-report questionnaires is an important

method for assessing social anxiety in adolescence. The self-report method is

especially important given the subjective and internalized nature of social anxiety

(Kearney, 2005). The instrument used in this study is Social Anxiety Scale for

Adolescents (SAS-A) by La Greca & Lopez, 1998. They conclude social anxiety

interventions would need to be qualitatively and fundamentally different for

adolescent not only in terms of intensity and duration, but also in their treatment

content and application.

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According to M.Wehry et.al (2015), increased to understanding of these

conditions and held outcomes for affected children and adolescents. The questionnaire

method used for anxiety patient is Multidimensional Anxiety Scale for Children

(MASC) by American Academic of Children and Adolescent Psychiatry, 2007 and

Screen for children Anxiety and Related Emotional Disorders (SCARED) by March

et.al, 1997. They found both highly prevalent to substantial morbidity and an

increased risk of suicide and self-injurious behaviour.

Freidl et.al (2017) focuses on the assessment and treatment of anxiety

disorders among children and adolescents. The method used comprehensive

assessment of child and adolescent anxiety disorders include use of semi structured

interviews; child and informant questionnaires; collateral information from parents,

teachers, pediatricians, and school psychologists; and behavioral observations. In

conclusion, medication-free period, CBT booster sessions, continued parents’ work,

and classroom-based accommodations may continue to be important interventions.

Sluis (2017) the studies aim of this dissertation was to gain more knowledge

about the maintenance, assessment and treatment of anxiety disorders in children.

Self- reported method used to identify children who consistently show high anxiety.

In this way, more children in need of treatment can be offered effective interventions.

These indicate children seem to have an impact on their parents, and with the right

age adjustments, can be helpful informants and clients in their own diagnostic and

treatment process.

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ASSESSMENT AND TREATMENT ANXIETY DISORDER AMONG TEENAGERS AT UNIVERSITY
SUMMARY ASSESSMENT OF ANXIETY DISORDER

Authors Aim/opinion Instrument Finding

Cartwright-Hatton,  Assumption effected  SASC-R by LaGreca &  Suggested that socially anxious

Tschernitz and children skill deficits in Stone, 1993. individual merely believe that they have

Gomersall (2003) childhood social skill deficits.

anxiety.  Conclude therapists should be wary of

assuming that socially anxious children

are lacking in basic social skills.

Vitasari et.al  Assessed observed the  STAI by Spielherger  Suggested large of sample size to

(2010) relationship between 1993. strengthen the results.

study anxiety level and  Students have higher score in anxiety

students performance. achieve low ability to study.

J. Ingles et.al  A self-report  SAS-A by La Greca &  Conclude social anxiety interventions

(2010) questionnaire is an Lopez, 1998. would need to be qualitatively and

important method. fundamentally.

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ASSESSMENT AND TREATMENT ANXIETY DISORDER AMONG TEENAGERS AT UNIVERSITY

M.Wehry et.al  Understanding of these  MASC by American  Conclude both highly prevalent to

(2015), conditions and held Academic of Children substantial morbidity and an increased

outcomes for affected and Adolescent risk of suicide and self-injurious

children and Psychiatry, 2007. behaviour.

adolescents.  SCARED by March

et.al, 1997.

Freidl et.al  Focuses on the  Comprehensive  Conclude medication-free period, CBT

(2017) assessment and assessment. booster sessions, continued parents’

treatment of anxiety work, and classroom-based

disorders. accommodations may continue to be

important interventions.

Sluis  To gain more  Self-report.  More children in need of treatment can

(2017) knowledge about the be offered effective interventions.

maintenance,

assessment and

treatment of anxiety

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disorders in children.

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2.5 TREATMENT OF ANXIETY DISORDER

According to M.Wehry et.al (2015), these disorders are amenable to treatment,

both psychopharmacologic and psychotherapeutic and there has been a surge in

evidence for exposure-based CBT and SSRIs/SSNRIs in the treatment of childhood

anxiety disorders. They suggest that SSRIs and SSNRIs are efficacious and well-

tolerated. However, placebo-controlled studies recommended not support the efficacy

of benzodiazepines or buspirone in the treatment of youth with anxiety disorders.

The focus on treatment by Ford (2016) was pharmacological treatment in

anxiety. The treatment of anxiety is crucial to the patient physical and emotional

health as well as their well-being. The effective management of anxiety in patients is

multimodal and includes psychotherapy, behavioral therapy, and pharmacological

management. The efficacy of one of these treatments alone depends on the severity of

the anxiety and the patient setting.

Sluis (2017) focus of treatment was on cognitive behavioral therapy (CBT)

interventions to reduce child anxiety. One was a 2 group CBT for the parents

(henceforth parent intervention) and the young child itself (henceforth child

intervention). From the outcome of the both treatments are not directly comparable,

the post-hoc tested differences in effect sizes between the two treatments were not

significant, all p’s > .05. Thus, the child intervention did not perform the parent

intervention, or vice versa. These results indicate that both treatments the lack of

differences treated effectively on their own, with only minimal parental involvement.

Sluis (2017) cognitive behavioral therapy (CBT) typically includes these steps:

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a) Identify troubling situations or conditions in patient life. These may

include such issues as a medical condition, divorce, grief, anger or

symptoms of a mental illness. Patients and therapist may spend some

time deciding what problems and goals want to focus on.

b) Become aware of patient thoughts, emotions and beliefs about these

problems. Identified the problems to work on, therapist will encourage

to share patient thoughts about them. This may include observing what

patient tell themselves about an experience (self-talk), interpretation of

the meaning of a situation, and beliefs about themselves, other people

and events. The therapist may suggest that you keep a journal of

patient thoughts.

c) Identify negative or inaccurate thinking. To help patient recognize

patterns of thinking and behaviour that may be contributing to their

problem, therapist may ask patient to pay attention to their physical,

emotional and behavioural responses in different situations.

d) Reshape negative or inaccurate thinking. The therapist will likely

encourage patient to ask themselves whether their view of a situation is

based on fact or on an inaccurate perception of what's going on. This

step can be difficult. Patient may have long-standing ways of thinking

about their life. With practice, helpful thinking and behaviour patterns

will become a habit and not take as much effort.

Freidl et.al (2017) highlighted psychosocial interventions, cognitive

behavioral therapy (CBT) and exposure-based therapies have emerged as the most

well-established treatment approaches for addressing anxiety disorders among

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ASSESSMENT AND TREATMENT ANXIETY DISORDER AMONG TEENAGERS AT UNIVERSITY

children and adolescents. These indicates Research indicates that CBT plus SSRI

medication is the most effective treatment of anxiety for youths ages seven to 17,

compared with either CBT or medication alone. Also, medication monotherapy and

CBT monotherapy have demonstrated to be effective treatments.

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TREATMENT OF ANXIETY DISORDER

Type of Anxiety Disorder Treatment

Obsessive-Compulsive Cognitive Behavioral Therapy:


Disorder  larger grey matter volumes in medial PFC
 increased metabolism in OFC

Pharmacotherapy:
 smaller grey matter volumes in right middle lateral
OFC
 decreased metabolic activity in OFC
 increased right caudate nucleus metabolism
 SERT availability in thalamic and hypothalamic brain
regions
 lower regional cerebral flood flow in OFC and higher
regional cerebral flood flow
 in bilateral posterior cingulate cortex in response to
symptom provocation
 increased right cerebellum and left STG activity to
illness-related words
Generalized Anxiety Pharmacotherapy:
Disorder  hyperactivity in the pregenual ACC in response to
anticipation of aversive and
 neutral stimuli
 increased activity in the rostral ACC and decreased
amygdala activity when
 viewing fearful faces
Social Anxiety Disorder Cognitive Behavioral Therapy:
 reduced dopamine D2 receptor binding in medial PFC
and hippocampus
 increased activity in right occiptotemporal brain areas
in response to response to
 angry vs. neutral faces
Panic Disorder Cognitive Behavioral Therapy:
 Provided in 12-16 sessions.
 Focuses on recreating fear symptoms and helping
patients change their response to them.

Source: Jappe, Dougan and Cullen (2013), pg. 290

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