Anxiety
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Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events.[2][3][4] Anxiety is different from fear in that fear is defined as the emotional response to a real threat, whereas anxiety is the anticipation of a future threat.[5] It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.[6]
Anxiety is a feeling of uneasiness and
The emotion of anxiety can persist beyond the developmentally appropriate time-periods in response to specific events, and thus turning into one of the multiple
Anxiety vs. fear
Anxiety is distinguished from
Fear and anxiety can be differentiated into four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short-lived, present-focused, geared towards a specific threat, and facilitating escape from threat. On the other hand, anxiety is long-acting, future-focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[21]
Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.[22][23]
Symptoms
Anxiety can be experienced with long, drawn-out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety.[24] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. However, most people do not suffer from chronic anxiety.[25]
Anxiety can induce several psychological pains (e.g.
The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.[9] Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping).[9]
The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank"[29] as well as "nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary."[30] It may include a vague experience and feeling of helplessness.[31]
The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying: "You may ... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can't get it out of your mind."[32]
The physiological symptoms of anxiety may include:[26][27]
- Neurological, as presyncope.
- Digestive, as abdominal pain, nausea, diarrhea, indigestion, dry mouth, or bolus. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS.
- Respiratory, as shortness of breath or sighing breathing.
- Cardiac, as palpitations, tachycardia, or chest pain.
- Muscular, as .
- Cutaneous, as perspiration, or itchy skin.
- Uro-genital, as chronic pelvic pain syndrome.
Types
There are various types of anxiety.
Existential
The philosopher Søren Kierkegaard, in The Concept of Anxiety (1844), described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote that the psychological trauma of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation, and differentiation.[33]
The
According to Viktor Frankl, the author of Man's Search for Meaning, when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a meaning of life to combat the "trauma of nonbeing" as death is near.[35]
Depending on the source of the threat, psychoanalytic theory distinguishes the following types of anxiety, namely realistic, neurotic and moral.[36]
Test, performance, and competitive
Test
According to
Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an
Research indicates that test anxiety among U.S. high-school and college students has been rising since the late 1950s. Test anxiety remains a challenge for students, regardless of age, and has considerable physiological and psychological impacts.[42] Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.[43] The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions.[44]
Performance and competitive
Performance anxiety and competitive anxiety (competitive trait anxiety, competitive state anxiety) happen when an individual's performance is measured against others. An important distinction between competitive and non-competitive anxiety is that competitive anxiety makes people view their performance as a threat.[45] As a result, they experience a drop in their ordinary ability, whether physical or mental, due to that perceived stress.[46]
Competitive anxiety is caused by a range of internal factors including high expectations, outside pressure,[46] lack of experience, and external factors like the location of a competition.[47] It commonly occurs in those participating in high pressure activities like sports and debates. Some common symptoms of competitive anxiety include muscle tension, fatigue, weakness, sense of panic, apprehensiveness, and panic attacks.[48]
There are 4 major theories of how anxiety affects performance: Drive theory, Inverted U theory, Reversal theory, and The Zone of Optimal Functioning theory.
Drive theory believes that anxiety is positive and performance improves proportionally to the level of anxiety. This theory is not well accepted.[49]
The Inverted U theory is based on the idea that performance peaks at a moderate stress level. It is called Inverted U theory because the graph that plots performance against anxiety looks like an inverted "U".[49]
Reversal theory suggests that performance increases in relation to the individual's interpretation of their arousal levels. If they believed their physical arousal level would help them, their performance would increase, if they didn't, their performance would decrease.[46] For example: Athletes were shown to worry more when focusing on results and perfection rather than the effort and growth involved.[45]
The Zone of Optimal Functioning theory proposes that there is a zone where positive and
Stranger, social, and intergroup anxiety
Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.[51]
Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. "Stranger anxiety" in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. According to Cutting, social phobics do not fear the crowd but the fact that they may be judged negatively.[52]
Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those with this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including avoidant personality disorder.[53]
To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.[54]
As is the case with the more generalized forms of
Trait
Anxiety can be either a short-term "state" or a long-term "personality trait". Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not).[60] A meta-analysis showed that a high level of neuroticism is a risk factor for development of anxiety symptoms and disorders.[61] Such anxiety may be conscious or unconscious.[62]
Personality can also be a trait leading to anxiety and depression and their persistence.[12] Through experience, many find it difficult to collect themselves due to their own personal nature.[63]
Choice or decision
Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations.[64] In 2004, Capgemini wrote: "Today we're all faced with greater choice, more competition and less time to consider our options or seek out the right advice."[65]
In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making.[66] There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.[66]
Panic disorder
Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S. Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear.[67] Someone with panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual's general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they have these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.[68]
Anxiety disorders
Anxiety disorders are a group of
Anxiety disorders are caused by a complex combination of
Without treatment, anxiety disorders tend to remain.
About 12% of people are affected by an anxiety disorder in a given year and between 12% and 30% are affected at some point in their life.[74][76] They occur about twice as often in women than they do in men, and generally begin before the age of 25.[8][74] The most common anxiety disorders are specific phobias, which affect nearly 12% of people, and social anxiety disorder, which affects 10% of people at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.[74]
Short- and long-term anxiety
Anxiety can be either a short-term "state" or a long-term "trait". Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fears.[8]
Four ways to be anxious
In his book Anxious: The Modern Mind in the Age of Anxiety[77] Joseph LeDoux examines four experiences of anxiety through a brain-based lens:
- In the presence of an existing or imminent external threat, you worry about the event and its implications for your physical and/or psychological well-being. When a threat signal occurs, it signifies either that danger is present or near in space and time or that it might be coming in the future. Nonconscious threats processing by the brain activates defensive survival circuits, resulting in changes in information processing in the brain, controlled in part by increases in arousal and behavioral and physiological responses in the body that then produce signals that feed back to the brain and complement the physiological changes there, intensifying them and extending their duration.
- When you notice body sensations, you worry about what they might mean for your physical and/or psychological well-being. The trigger stimulus does not have to be an external stimulus but can be an internal one, as some people are particularly sensitive to body signals.
- Thoughts and memories may lead to you to worry about your physical and/or psychological well-being. We do not need to be in the presence of an external or internal stimulus to be anxious. An episodic memory of a past trauma or of a panic attack in the past is sufficient to activate the defence circuits.
- Thoughts and memories may result in existential dread, such as worry about leading a meaningful life or the eventuality of death. Examples are contemplations of whether one's life has been meaningful, the inevitability of death, or the difficulty of making decisions that have a moral value. These do not necessarily activate defensive systems; they are more or less pure forms of cognitive anxiety.
Co-morbidity
Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, bipolar disorder, eating disorders, or certain personality disorders. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.[78][79]
It is common for those with
Risk factors
Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety.[83] Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence.[84] Specific measured 'environments' that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty.[85] Anxiety is also associated with drug use, including alcohol, caffeine, and benzodiazepines, which are often prescribed to treat anxiety. ,
Neuroanatomy
Neural circuitry involving the amygdala, which regulates emotions like anxiety and fear, stimulating the HPA axis and sympathetic nervous system, and hippocampus, which is implicated in emotional memory along with the amygdala, is thought to underlie anxiety.[86] People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala.[87] Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.[88][89]
Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.[90] This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents".[90]
The gut-brain axis
The microbes of the gut can connect with the brain to affect anxiety.
Another key pathway is the
With this communication comes the potential to treat.
Genetics
Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[99] Estimates of genetic influence on anxiety, based on studies of twins, range from 25 to 40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[70] Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence.[100][101] When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design.[102]
Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated,
Epigenetics
Epigenetic modifications play a role in the development and heritability of these disorders and related symptoms. For example, regulation of the hypothalamus-pituitary-adrenal axis by glucocorticoids plays a major role in stress response and is known to be epigenetically regulated.
As of 2015 most work has been done inMedical conditions
Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like
Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.
Substance-induced
Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include
While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated.[130][131] Acute exposure to toxic levels of benzene may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.[132]
Psychological
Poor
Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional reasoning, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad "always" happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment. In addition, those who have high anxiety can also create future stressful life events.[136] Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well as stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.
Evolutionary psychology
An
When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased blood flow in the amygdala.[139][140] In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.
Social
Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), bullying, early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including those with disabilities), and socioeconomics (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries).[141] A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders.[142] Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.
Gender socialization
Contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence, self-efficacy, independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences.[143]
Treatment
The first step in the management of a person with anxiety symptoms involves evaluating the possible presence of an underlying medical cause, the recognition of which is essential in order to decide the correct treatment.[26][119] Anxiety symptoms may mask an organic disease, or appear associated with or as a result of a medical disorder.[26][119][144][27]
Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line treatment.[145][146][147][148][149] CBT appears to be equally effective when carried out via the internet.[149] While evidence for mental health apps is promising, it is preliminary.[150][151]
Anxiety often affects relationships, and interpersonal psychotherapy addresses these issues by improving communication and relationship skills.[152]
Psychopharmacological treatment can be used in parallel to CBT or can be used alone. As a general rule, most anxiety disorders respond well to first-line agents. Such drugs, also used as anti-depressants, are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, that work by blocking the reuptake of specific neurotransmitters and resulting in the increase in availability of these neurotransmitters. Additionally, benzodiazepines are often prescribed to individuals with anxiety disorder. Benzodiazepines produce an anxiolytic response by modulating GABA and increasing its receptor binding. A third common treatment involves a category of drug known as serotonin agonists. This category of drug works by initiating a physiological response at 5-HT1A receptor by increasing the action of serotonin at this receptor.[citation needed] Other treatment options include pregabalin, tricyclic antidepressants, and moclobemide, among others.[153]
Anxiety is considered to be a serious psychiatric illness that has an unknown true pervasiveness due to affected individuals not asking for proper treatment or aid, and due to professionals missing the diagnosis.[4]
Prevention
The above risk factors give natural avenues for prevention. A 2017 review found that psychological or educational interventions have a small yet statistically significant benefit for the prevention of anxiety in varied population types.[154][155][156]
Pathophysiology
Anxiety disorder appears to be a genetically inherited neurochemical dysfunction that may involve autonomic imbalance; decreased GABA-ergic tone; allelic polymorphism of the catechol-O-methyltransferase (COMT) gene; increased adenosine receptor function; increased cortisol.[157]
In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Increased flow in the right parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients are the diagnostic factors for prevalence of anxiety disorder.
The amygdala is central to the processing of fear and anxiety,[158] and its function may be disrupted in anxiety disorders. Anxiety processing in the basolateral amygdala has been implicated with expansion of dendritic arborization of the amygdaloid neurons.[159] SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization.[160]
See also
- List of people with an anxiety disorder
- Angst – Intense feeling of apprehension, anxiety, or inner turmoil
- Fear – Basic emotion induced by a perceived threat
- Tripartite Model of Anxiety and Depression
- Uncanny – Psychological experience of something being strangely familiar
References
- ISBN 978-0-465-02411-7.
- ISBN 978-0-470-84072-6.
- ISBN 978-0-19-150927-8. Archivedfrom the original on 2023-01-17. Retrieved 2022-05-09.
- ^ from the original on 2022-06-21. Retrieved 2022-12-15.
Anxiety is linked to fear and manifests as a future-oriented mood state that consists of a complex cognitive, affective, physiological, and behavioral response system associated with preparation for the anticipated events or circumstances perceived as threatening.
- PMID 26487812.
- ^ Seligman ME, Walker EF, Rosenhan DL. Abnormal psychology (4th ed.). New York: W.W. Norton & Company.[page needed]
- ]
- ^ ISBN 978-0-89042-555-8.
- ^ ISBN 978-0-340-81026-2.[page needed]
- S2CID 195758112.
Anxiety is an adaptive response that promotes harm avoidance, but at the same time excessive anxiety constitutes the most common psychiatric complaint.
- from the original on 2021-12-16. Retrieved 2021-06-02.
- ^ (PDF) from the original on 2023-04-05. Retrieved 2023-04-05.
- S2CID 13129793.
- ^ World Health Organization (2023). International Classification of Diseases, eleventh revision – ICD-11. Genova – icd.who.int.
- ^ Andreas Dorschel, Furcht und Angst. In: Dietmar Goltschnigg (ed.), Angst. Lähmender Stillstand und Motor des Fortschritts. Stauffenburg, Tübingen 2012, pp. 49–54
- from the original on 2021-12-16. Retrieved 2020-12-13.
- ISBN 978-1-57230-529-8.
- PMID 11280938.
- Gale A288874227.
- ISBN 978-0-465-04513-6.[page needed]
- PMID 20817337.
- ^ Emory M (June 7, 2018). "On Fear, Emotions, and Memory: An Interview with Dr. Joseph LeDoux". Brain World. Archived from the original on April 22, 2021. Retrieved September 11, 2019.
- PMID 27798257.
- S2CID 24207457.
- ^ "Generalized Anxiety Disorder". National Institute of Mental Health (NIMH). Archived from the original on 2023-03-29. Retrieved 2023-03-29.
- ^ ISBN 978-92-4-154769-7. Archived(PDF) from the original on November 20, 2016.
- ^ from the original on 2021-02-26. Retrieved 2018-10-26.
- ^ "Depression Hotline | Call Our Free, 24 Hour Depression Helpline". PsychGuides.com. Archived from the original on October 11, 2018. Retrieved October 11, 2018.
- ^ Smith M (June 2008). "Anxiety attacks and disorders: Guide to the signs, symptoms, and treatment options". Helpguide. Archived from the original on 7 March 2009. Retrieved 3 March 2009.
- ^ Folk J (13 October 2021) [1987]. Liashko V (ed.). "Anxiety Symptoms, Causes, Treatment". Anxiety Centre. Archived from the original on March 7, 2009. Retrieved 3 March 2009.
- (PDF) from the original on 2023-08-12. Retrieved 2023-08-28.
- ^ Folk J (27 March 2021) [1987]. Folk M (ed.). "Anxiety symptoms – Fear of dying". Anxiety Centre. Archived from the original on March 5, 2009. Retrieved 3 March 2009.
- ISBN 978-0-393-30574-6.
- ^ ISBN 978-0-300-08471-9.
- ISBN 978-1-107-09707-0.
- ISBN 978-0-07-029063-1.
- S2CID 145516099.
- ISSN 2562-4687.
- S2CID 33689633.
- S2CID 38476947.
- PMID 9256517.
- S2CID 258190141.
- CiteSeerX 10.1.1.1027.7497. Archived(PDF) from the original on 2022-10-09.
- (PDF) from the original on 2022-10-09.
- ^ PMID 26896951.
- ^ PMID 29138604.
- ISSN 1875-6867.
- PMID 31379665.
- ^ from the original on 2024-02-23. Retrieved 2023-03-30.
- ISBN 978-0-470-17024-3. Archivedfrom the original on 2023-03-30. Retrieved 2023-03-30.
- ISBN 978-0-12-375096-9.
- ISBN 978-0-7234-2590-8.[page needed]
- S2CID 39915581.
- .
- S2CID 11212529.
- PMID 2768658.
- .
- PMID 22775128.
- S2CID 8581417.
- ^ Schwarzer R, et al. (Psychosocial Working Group) (December 1997). "Anxiety". MacArthur SES & Health Network. Archived from the original on 7 March 2018.
- ^ from the original on 2019-07-24. Retrieved 2019-07-28.
- ISBN 978-0-412-41210-3.[page needed]
- ^ "Gulf Bend MHMR Center". Archived from the original on October 11, 2018. Retrieved October 11, 2018.
- ^ Downey J (April 27, 2008). "Premium choice anxiety". The Times. London. Archived from the original on February 3, 2014. Retrieved April 25, 2010.
- ^ Is choice anxiety costing british 'blue chip' business? Archived December 22, 2015, at the Wayback Machine, Capgemini, August 16, 2004
- ^ PMID 22325982.
- ^ "What are the five major types of anxiety disorders?". U.S. Department of Health & Human Services. June 8, 2015. Archived from the original on October 25, 2019. Retrieved October 25, 2019.
- ^ "Panic Disorder & Panic Attacks". The Cleveland Clinic. Archived from the original on 2019-10-05. Retrieved 2019-10-25.
- ^ Hurley K. "Anorexia & Depression: When Eating Disorders Co-Exist with Depression". Psycom.net - Mental Health Treatment Resource Since 1986. Archived from the original on 2020-06-04. Retrieved 2020-06-05.
- ^ PMID 28867940.
- ^ "Anxiety". medlineplus.gov. Archived from the original on 2021-10-27. Retrieved 2021-10-27.
- S2CID 202672894.
- ^ a b "Anxiety Disorders". NIMH. March 2016. Archived from the original on July 27, 2016. Retrieved August 14, 2016.
- ^ S2CID 208789585.
- PMID 36796860.
- PMID 18188442.
- OCLC 920462582.
- PMID 29540840.
- .
- S2CID 17606388.
- S2CID 251511163.
- ISBN 978-5-00050-775-9.[page needed]
- S2CID 141211176.
- S2CID 35349081.
- S2CID 52852105.
- PMID 9577241.
- ^ Nolen-Hoeksema S (2013). (Ab)normal Psychology (6th ed.). McGraw Hill.[page needed]
- ISBN 978-1-4214-0220-8.
- ISBN 978-0-7890-0408-6.
- ^ PMID 19594857.
- ^ hdl:10807/229103.
- ^ S2CID 12743048.
- ^ PMID 25772005.
- ^ S2CID 40601114.
- ^ PMID 21876150.
- S2CID 206106596.
- S2CID 2132501.
- PMID 25449699.
- PMID 31715324.
- PMID 24920372.
- S2CID 15183002.
- PMID 25906669.
- ^ S2CID 3394824.
- ^ PMID 31748690.
- PMID 26754954.
- S2CID 54353612.
- PMID 27542431.
- PMID 27264777.
- PMID 26929625.
- PMID 27605876.
- S2CID 19634934.
- from the original on 2020-07-26. Retrieved 2019-12-07.
- PMID 27652216.
- PMID 27799808.
- PMID 27822464.
- PMID 26315692.
- ^ from the original on 2021-03-04. Retrieved 2018-10-26.
- S2CID 27235034.
- S2CID 19858996.
- PMID 12479986.
- PMID 25922673.
- S2CID 207050854.
- PMID 27411754.
- PMID 26540080.
- PMID 27141858.
- PMID 25583845.
- ^ National Institute on Drug Abuse (2012-08-03). "Prescription Drug Facts, Effects, Teen Use". NIDA for Teens. Archived from the original on 2022-05-18. Retrieved 2022-05-24.
- PMID 23731428.
- PMID 29999576.
- ^ "CDC – The Emergency Response Safety and Health Database: Systemic Agent: BENZENE – NIOSH". www.cdc.gov. Archived from the original on January 17, 2016. Retrieved January 27, 2016.
- PMID 20374540.
- PMID 18298268.
- S2CID 95140.
- PMID 25572915.
- PMID 19618990.
- ISBN 978-0-19-923639-8.
- PMID 9108115.
- S2CID 6278342.
- from the original on 2014-04-18. Retrieved 2014-04-19.
- PMID 31385212.
- S2CID 144320186.
- from the original on 2021-05-05. Retrieved 2018-10-26.
- PMID 26580998.
- S2CID 46188773.
- PMID 22275847.
- PMID 27071857.
- ^ PMID 26968204.
- PMID 24240579.
- from the original on 2024-02-23. Retrieved 2022-12-28.
- ^ "Can Therapy Help with Anxiety? Understanding the Benefits". totalmentalwellnessfl.com. 2023-11-08. Archived from the original on 2024-02-23. Retrieved 2023-12-05.
- PMID 28867934.
- PMID 28877316.
- ^ Pote I (February 19, 2018). "Preventing anxiety with psychological and educational interventions". National Elf Service. Archived from the original on December 16, 2021. Retrieved December 12, 2019.
- S2CID 81782119.
- ^ Anxiety Disorders at eMedicine
- S2CID 16348363.
- PMID 18391224.
- PMID 19204724.