thesis statement for generalized anxiety disorder

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Generalized anxiety disorder.

Sadaf Munir ; Veronica Takov .

Affiliations

Last Update: October 17, 2022 .

Continuing Education Activity

Generalized anxiety disorder is a mental health disorder that produces fear, worry, and a constant feeling of being overwhelmed. It is characterized by excessive, persistent, and unrealistic worry about everyday things. This activity illustrates the evaluation and management of generalized anxiety disorder and explains the interprofessional team's role in managing patients with this condition.

Summarize the etiology of generalized anxiety disorder.
Describe the use of the Generalized Anxiety Disorder 7-Item Questionnaire in the evaluation of generalized anxiety disorder.
Identify the use of cognitive-behavioral therapy in the management of patients with a generalized anxiety disorder.
Outline the importance of collaboration and communication among the interprofessional team to enhance care delivery for patients affected by a generalized anxiety disorder.
Introduction

Generalized anxiety disorder is one of the most common mental disorders. Up to 20% of adults are affected by anxiety disorders each year. Generalized anxiety disorder produces fear, worry, and a constant feeling of being overwhelmed. Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive worry is the central feature of generalized anxiety disorder. [1] [2] [3]

Diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) include the following:

Excessive anxiety and worry for at least six months
Difficulty controlling the worrying.
The anxiety is associated with three or more of the below symptoms for at least 6 months:
Restlessness, feeling keyed up or on edge
Being easily fatigued
Difficulty in concentrating or mind going blank, irritability
Muscle tension
Sleep disturbance
Irritability
The anxiety results in significant distress or impairment in social and occupational areas
The anxiety is not attributable to any physical cause

The etiology may include:

A physical condition such as diabetes or other comorbidities such as depression
Genetic, first-degree relatives with generalized anxiety disorder (25%)
Environmental factors, such as child abuse
Substance use disorder
Epidemiology

Childhood anxiety occurs in about 1 in 4 children at some time between the ages of 13 and 18 years. The median age at onset is 11 years. However, the lifetime prevalence of a severe anxiety disorder in children ages 13 to 18 is approximately 6%. General prevalence in children younger than 18 years is between 5.7% and 12.8%. The prevalence is approximately twice as high among women as among men. [4] [5] [6]

The American Psychiatric Association first introduced the diagnosis of generalized anxiety disorder two decades ago in the DSM-III. Before that time, generalized anxiety disorder was conceptualized as one of the two core components of anxiety neurosis, the other being panic. A recognition that generalized anxiety disorder and panic, although often occurring together, are sufficiently distinct to be considered independent disorders led to their separation in the DSM-III.

The DSM-III definition of generalized anxiety disorder required uncontrollable and diffuse (i.e., not focused on a single major life problem) anxiety or worry that is excessive or unrealistic relative to objective life circumstances and persists for one month or longer. Several related psychophysiological symptoms were also required for a diagnosis of generalized anxiety disorder. Early clinical studies evaluating DSM-III, according to this definition, found that the disorder seldom occurred in the absence of another comorbid anxiety or mood disorder. Comorbidity of generalized anxiety disorder and major depression was especially strong and led some commentators to suggest that generalized anxiety disorder might better be conceptualized as a prodrome, residual, or severity marker than as an independent disorder. The rate of comorbidity of generalized anxiety disorder with other disorders decreases as the duration of generalized anxiety disorder increases. Based on this finding, the DSM-III-R committee on generalized anxiety disorder recommended that the duration required for the disorder be increased to six months. This change was implemented in the final version of the DSM-III-R. Additional changes in the definition of excessive worry and the required number of associated psychophysiological symptoms were made in the DSM-IV.

These changes in diagnostic criteria led to delays in cumulating data on the epidemiology of generalized anxiety disorder. Nonetheless, such data became available over the past decade. As described in more detail later, this new data challenged the view that generalized anxiety disorder should be conceptualized as a prodrome, residual, or severity marker of other disorders. Instead, it suggests that generalized anxiety disorder is a common disorder that, although often comorbid with other mental disorders, does not have a higher comorbidity rate than those found in most other anxiety or mood disorders. The new data also challenged the validity of the threshold decisions embodied in the DSM-5.

Pathophysiology

The exact mechanism is not entirely known. Anxiety can be a normal phenomenon in children. Stranger anxiety begins at seven to nine months of life. Noradrenergic, serotonergic, and other neurotransmitter systems appear to play a role in the body's response to stress. The serotonin system and the noradrenergic systems are common pathways involved in anxiety. Many believe that low serotonin system activity and elevated noradrenergic system activity are responsible for its development. Therefore, it is selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) that are the first-line agent for its treatment.

History and Physical

Patients with anxiety can pose a diagnostic challenge, as somatic symptoms are more common than psychological symptoms. Most patients present with vague or nonspecific somatic complaints, including, but not limited to, shortness of breath, palpitations, fatigability, headache, dizziness, and restlessness. Patients may also describe psychologic symptoms such as excessive, nonspecific anxiety and worry, emotional lability, difficulty concentrating, and insomnia.

Factors commonly associated with generalized anxiety include:

Female gender
Poor health
Low education
Presence of stressors

The median age of presentation is 30 years.

Many scales have been developed to assess the severity and diagnosis. The GAD-7 has been validated as a diagnostic tool and severity assessment scale.

Initial assessment begins by addressing behavioral or somatic symptoms. Evaluate for psychosocial stress, psychosocial difficulties, and developmental issues. Review past medical history, including trauma, psychiatric conditions, and substance abuse. [7]

The following evaluation may be obtained to exclude organic causes:

Thyroid function tests
Blood glucose level
Echocardiography
Toxicology screen

The Generalized Anxiety Disorder 7-Item (GAD-7) Questionnaire is a screening tool that can also be used to monitor patients with generalized anxiety disorder.

Treatment / Management

The two main treatments for generalized anxiety disorder are cognitive behavioral therapy and medications. Patients may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best. [8] [9] [10]

Cognitive Behavioral Therapy

This includes psychoeducation, changing maladaptive thought patterns, and gradual exposure to anxiety-provoking situations.

Pharmacotherapy

Patients who do not respond to cognitive behavioral therapy may be treated with medications. Some patients with severe symptoms are treated with both initially. Several types of medications are used to treat generalized anxiety disorder.

Antidepressants

Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) classes are the first-line agents with a response rate of 30% to 50%. This class of drugs includes escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR), and paroxetine (Paxil, Pexeva). In a study, 81% of children with anxiety disorders who received combined sertraline hydrochloride and CBT responded to the treatment.

Antipsychotics may also help some patients, especially those with associated behavior problems.

Benzodiazepines

Examples are diazepam and clonazepam, which are long-acting agents. These agents are used when an immediate reduction of symptoms is desired, or a short-term treatment is needed. Generally, cooperative and compliant patients who are aware that their symptoms have a psychological basis are more likely to respond to benzodiazepines. Since there is a concern for misuse and dependence, patients with a history of alcoholism or drug abuse are not appropriate candidates for this treatment.

Buspirone

Buspirone is a non-benzodiazepine that does not cause dependency. It is also less sedating than benzodiazepines, and tolerance does not occur at therapeutic doses. This agent has a therapeutic lag in the efficacy of two to three weeks, limiting its use.

All medications should be titrated slowly and continued for at least 4 weeks to determine if they work. Once symptoms are under control, the medications need to be used for at least 12 months before gradually tapering them. Every medication has adverse effects like weight gain, hyperlipidemia, and diabetes; thus, the patients need to be monitored.

Psychotherapy is used in addition to medications; this combination has proven to be effective.

The education of the patient is vital as it can help ease anxiety. The triggers for anxiety should be managed by avoiding caffeine, alcohol, nicotine, and stress) and improving sleep.

Many complementary and alternative remedies are available, but the evidence to support their efficacy is lacking. Further, some agents like Kava may injure the liver. Others, like St John's wort and hydroxytryptophan, may interact with SSRIs and induce serotonin syndrome.

Differential Diagnosis
Hyperthyroidism
Pheochromocytoma
Chronic obstructive pulmonary disease
Transient ischemic attack
Bipolar disorder
Use of caffeine, decongestants, and albuterol

The prognosis for patients with generalized anxiety disorder is guarded. Many patients are not compliant with medications because of cost and adverse effects. Relapses are common, and patients often search for physicians who comply with their needs. Because of the lack of conventional medicine to cure the disorder, many opt for alternative therapies without much success. Overall, the quality of life of these patients is poor.

Complications

Complications of generalized anxiety disorder can also lead to, or worsen, other mental and physical conditions [11] :

Depression (often presents concomitantly with an anxiety disorder)
Drug or alcohol use disorder
Gastrointestinal problems
Social isolation
Issues functioning at work/school
Impaired quality of life
Suicide potential
Deterrence and Patient Education

Patients with anxiety disorders need to understand the importance of medication compliance (anxiolytics, antidepressants, sleep inducers), working with any cognitive therapy prescribed, and the benefit of stopping the use of caffeine or other stimulants.

Pearls and Other Issues

Consider further evaluation for anxiety disorder if an adult is excessively anxious or an infant or child is excessively clingy and difficult to console during the pediatric visit. Many medical conditions may mimic anxiety disorders. One should distinguish between anxiety and illness and should evaluate for organic diseases before making this diagnosis.

Enhancing Healthcare Team Outcomes

Anxiety disorders are very common and can have a diverse presentation of signs and symptoms. The condition has very high morbidity and mortality and is best managed by an interprofessional team that includes a mental health nurse, pharmacist, psychologist, psychiatrist, and primary care provider. Many patients have moderate to severe symptoms, which lead to poor quality of life. Most have no idea that the condition can be treated. Thus, the key to improving outcomes is patient education. The nurse practitioner, pharmacist, and primary care provider should urge the patient to stop tobacco, alcohol, and caffeinated beverages. Also, relief of stress is vital, and thus a referral for cognitive behavior therapy may help.

Many drugs can be used to treat anxiety, but they all have side effects, which is a common reason for non-compliance. The pharmacist should emphasize the benefits of these medications and urge compliance to improve the symptoms. At the same time, the primary care provider should monitor for hyperlipidemia, diabetes, and weight gain due to the medications.

Overall, anxiety disorders are underdiagnosed and undertreated. When left untreated, anxiety disorders often lead to severe depression and abuse of drugs and alcohol. Additionally, there is a high rate of suicide among these patients. Many patients with chronic anxiety have a poor quality of life. The education of both the patient and family by the pharmacist, nurse, and provider as a team is important to reduce the high morbidity and addiction problems with treatment medications. Family members should help ensure medication compliance and provide a supportive environment. Unfortunately, despite optimal treatment, relapse rates are high. [12] [13] [14] [Level 5]

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Disclosure: Sadaf Munir declares no relevant financial relationships with ineligible companies.

Disclosure: Veronica Takov declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Thesis statements for research papers on generalized anxiety disorder

What would be a good thesis statement for a research paper on generalized anxiety disorder?

2 Answers By Expert Tutors

thesis statement for generalized anxiety disorder

Claudia D. answered • 04/29/21

High School Special Education English Teacher for 4 years

I find it easier to make thesis statements into an opinion, because having a stance and an emotion and tapping into my stubbornness really gives me energy! May not work for everyone but I find a bit of fun in most assignments this way. I like to picture the person who will disagreeing with me and now I have a whole research paper to prove them wrong.

You can also leave room for a call to action by the conclusion by setting yourself at the beginning. Would love to hear what opinions you have about GAD. Usually you do have one, but the work is trying to get it to be specific enough to have a single direction but broad enough to write a whole paper on.

Vicky C. answered • 04/28/21

Several years experience as a TA, specialties in Eng & Psych

Hi! It may be helpful to remember that a quality thesis statement, regardless of the topic will meet certain criteria. For example, it should be very clear and focused on a narrow topic and be a statement that is arguable *(so that someone could argue for or against it with evidence and support). The statement should also be written in a way that conveys your position on the argument.

There could be endless possibilities here but maybe for a paper covering GAD (generalized anxiety disorder) one could pose a thesis statement such as, " A diagnosis of generalized anxiety disorder in an individual increases the chances of physical health complications" or "Generalized anxiety disorder has very serious implications for women in particular".

Whichever thesis statement you come up with, just be sure that you can find enough scholarly resources to support your position. Good luck!

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AMY B. LOCKE, MD, FAAFP, NELL KIRST, MD, AND CAMERON G. SHULTZ, PhD, MSW

A more recent article on generalized anxiety disorder and panic disorder in adults is available.

Am Fam Physician. 2015;91(9):617-624

Patient information : See related handout on anxiety and panic disorders , written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States, and they can negatively impact a patient's quality of life and disrupt important activities of daily living. Evidence suggests that the rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes. Diagnosing GAD and PD requires a broad differential and caution to identify confounding variables and comorbid conditions. Screening and monitoring tools can be used to help make the diagnosis and monitor response to therapy. The GAD-7 and the Severity Measure for Panic Disorder are free diagnostic tools. Successful outcomes may require a combination of treatment modalities tailored to the individual patient. Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective. Among psychotherapeutic treatments, cognitive behavior therapy has been studied widely and has an extensive evidence base. Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited by risk of abuse and adverse effect profiles. Physical activity can reduce symptoms of GAD and PD. A number of complementary and alternative treatments are often used; however, evidence is limited for most. Several common botanicals and supplements can potentiate serotonin syndrome when used in combination with antidepressants. Medication should be continued for 12 months before tapering to prevent relapse.

Generalized anxiety disorder (GAD) and panic disorder (PD) are among the most common mental disorders in the United States and are often encountered by primary care physicians. The hallmark of GAD is excessive, out-of-control worry, and PD is characterized by recurrent and unexpected panic attacks. Both conditions can negatively impact a patient's quality of life and disrupt important activities of daily living. The rates of missed diagnoses and misdiagnosis of GAD and PD are high, with symptoms often ascribed to physical causes.

This article reviews the diagnosis and management of GAD and PD in adults. Diagnosis and care of children and adolescents with these conditions require special considerations that are beyond the scope of this review.

Epidemiology, Etiology, and Pathophysiology

The 12-month prevalence for GAD and PD among U.S. adults 18 to 64 years of age is 2.9% and 3.1%, respectively. In this population, the lifetime prevalence is 7.7% in women and 4.6% in men for GAD, and is 7.0% in women and 3.3% in men for PD. 1

The etiology of GAD is not well understood. There are several theoretical models, each with varying degrees of empirical support. An underlying theme to several models is the dysregulation of worry. Emerging evidence suggests that patients with GAD may experience persistent activation of areas of the brain associated with mental activity and introspective thinking following worry-inducing stimuli. 2 Twin studies suggest that environmental and genetic factors are likely involved. 3

The etiology of PD is also not well understood. The neuroanatomical hypothesis suggests that a genetic-environment interaction is likely responsible. Patients with PD may exhibit irregularities in specific brain structures, altered neuronal processes, and dysfunctional corticolimbic interaction during emotional processing. 4

Typical Presentation and Diagnostic Criteria

Generalized anxiety disorder.

Patients with GAD typically present with excessive anxiety about ordinary, day-today situations. The anxiety is intrusive, causes distress or functional impairment, and often encompasses multiple domains (e.g., finances, work, health). The anxiety is often associated with physical symptoms, such as sleep disturbance, restlessness, muscle tension, gastrointestinal symptoms, and chronic headaches. 5 Diagnostic and Statistical Manual of Mental Disorders , 5th ed, (DSM-5) diagnostic criteria for GAD are listed in Table 1 . 5 Some factors associated with GAD include female sex, unmarried status, lower education level, poor health, and presence of life stressors. 6 The age of onset is variable, with a median age of 30 years. 1

A number of scales are available to establish diagnosis and assess severity. The GAD-7 ( Table 2 7 ) has been validated as a diagnostic tool and a severity assessment scale, with a score of 10 or more having good diagnostic sensitivity and specificity. 8 Greater GAD-7 scores correlate with more functional impairment. 8 The scale was developed and validated based on DSM-IV criteria, but it remains clinically useful after publication of the DSM-5 because the differences in GAD diagnostic criteria are minimal. The PRO-MIS Emotional Distress–Anxiety–Short Form for adults and the Severity Measure for Generalized Anxiety Disorder–Adult, available from the American Psychiatric Association at http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures , are intended to aid clinical evaluation of GAD and monitor treatment effectiveness.

PANIC DISORDER

PD is characterized by episodic, unexpected panic attacks that occur without a clear trigger. 5 Panic attacks are defined by the rapid onset of intense fear (typically peaking within about 10 minutes) with at least four of the physical and psychological symptoms in the DSM-5 diagnostic criteria ( Table 3 ) . 5 Another requirement for the diagnosis of PD is that the patient worries about further attacks or modifies his or her behavior in maladaptive ways to avoid them. The most common physical symptom accompanying panic attacks is palpitations. 9 Although unexpected panic attacks are required for the diagnosis, many patients with PD also have expected panic attacks, occurring in response to a known trigger. 9 The Severity Measure for Panic Disorder–Adult ( http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/SeverityMeasureForPanicDisorderAdult.pdf ) is an assessment scale that can complement the clinical assessment of patients with PD.

Differential Diagnosis and Comorbidity

When evaluating a patient for a suspected anxiety disorder, it is important to exclude medical conditions with similar presentations (e.g., endocrine conditions such as hyperthyroidism, pheochromocytoma, or hyperparathyroidism; cardiopulmonary conditions such as arrhythmia or obstructive pulmonary diseases; neurologic diseases such as temporal lobe epilepsy or transient ischemic attacks). Other psychiatric disorders (e.g., other anxiety disorders, major depressive disorder, bipolar disorder); use of substances such as caffeine, albuterol, levothyroxine, or decongestants; or substance withdrawal may also present with similar symptoms and should be ruled out. 5

Complicating the diagnosis of GAD and PD is that many conditions in the differential diagnosis are also common comorbidities. Additionally, many patients with GAD or PD meet criteria for other psychiatric disorders, including major depressive disorder and social phobia. Evidence suggests that GAD and PD usually occur with at least one other psychiatric disorder, such as mood, anxiety, or substance use disorders. 10 When anxiety disorders occur with other conditions, historic, physical, and laboratory findings may be helpful in distinguishing each diagnosis and developing appropriate treatment plans.

Some studies evaluating anxiety treatments assess non-specific anxiety-related symptoms rather than the set of symptoms that characterize GAD or PD. When possible, the treatments described in this section will differentiate between GAD and PD; otherwise, treatments refer to anxiety-related symptoms in general.

Medication or psychotherapy is a reasonable initial treatment option for GAD and PD. 11 Some studies suggest that combining medication and psychotherapy may be more effective for patients with moderate to severe symptoms. 12 The National Institute for Health and Care Excellence (NICE) guidelines on GAD and PD in adults are a useful review of available evidence; however, information about self-help and group therapies may have less utility in the United States because of their relative lack of availability. 11

Compassionate listening and education are an important foundation in the treatment of anxiety disorders. 11 Patient education itself can help reduce anxiety, particularly in PD. 13 The establishment of a therapeutic alliance between the patient and physician is important to allay fears of interventions and to progress toward treatment.

Common lifestyle recommendations that may reduce anxiety-related symptoms include identifying and removing possible triggers (e.g., caffeine, stimulants, nicotine, dietary triggers, stress), and improving sleep quality/quantity and physical activity.

Caffeine can trigger PD and other types of anxiety. Those with PD may be more sensitive to caffeine than the general population because of genetic polymorphisms in adenosine receptors. 14 Smoking cessation leads to improved anxiety scores, with relapse leading to increased anxiety. Many studies show an association between disordered sleep and anxiety, but causality is unclear. 15 In addition to decreased depression and anxiety, physical activity is associated with improved physical health, life satisfaction, cognitive functioning, and psychological well-being. Physical activity is a cost-effective approach in the treatment of GAD and PD. 16 , 17 Exercising at 60% to 90% of maximal heart rate for 20 minutes three times weekly has been shown to decrease anxiety 16 ; yoga is also effective. 18

First-Line Therapies . A number of medications are available for treating anxiety ( Table 4 ) . Selective serotonin reuptake inhibitors (SSRIs) are generally considered first-line therapy for GAD and PD. 19 – 22 Tricyclic antidepressants (TCAs) are better studied for PD, but are thought to be effective for both GAD and PD. 19 , 20 In the treatment of PD, TCAs are as effective as SSRIs, but adverse effects may limit the use of TCAs in some patients. 23 Venlafaxine, extended release, is effective and well tolerated for GAD and PD, whereas duloxetine (Cymbalta) has been adequately evaluated only for GAD. 24 Azapirones, such as buspirone (Buspar), are better than placebo for GAD 25 but do not appear to be effective for PD. 26 Mixed evidence suggests bupropion (Wellbutrin) may have anxiogenic effects for some patients, thus warranting close monitoring if used for treatment of comorbid depression, seasonal affective disorder, or smoking cessation. 27 Bupropion is not approved for the treatment of GAD or PD.

Medications should be titrated slowly to decrease the initial activation. Because of the typical delay in onset of action, medications should not be considered ineffective until they are titrated to the high end of the dose range and continued for at least four weeks. Once symptoms have improved, medications should be used for 12 months before tapering to limit relapse. 11 Some patients will require longer treatment.

Benzodiazepines are effective in reducing anxiety, but there is a dose-response relationship associated with tolerance, sedation, confusion, and increased mortality. 28 When used in combination with antidepressants, benzodiazepines may speed recovery from anxiety-related symptoms but do not improve longer-term outcomes. The higher risk of dependence and adverse outcomes complicates the use of benzodiazepines. 29 NICE guidelines recommend only short-term use during crises. 11 Benzodiazepines with an intermediate to long onset of action (such as clonazepam [Klonopin]) may have less potential for abuse and less risk of rebound. 30

Second-Line Therapies . Second-line therapies for GAD include pregabalin (Lyrica) and quetiapine (Seroquel), although neither has been evaluated for PD. Pregabalin is more effective than placebo but not as effective as lorazepam (Ativan) for GAD. Weight gain is a common adverse effect of pregabalin. There is limited evidence for the use of antipsychotics to treat anxiety disorders. Although quetiapine seems to be effective for GAD, the adverse effect profile is significant, including weight gain, diabetes mellitus, and hyperlipidemia. 31 Hydroxyzine is considered a second-line treatment for GAD, 32 but there are minimal data for its use in PD. Its rapid onset can be appealing for patients needing immediate relief, and it may be a more appropriate alternative if benzodiazepines are contraindicated (e.g., in patients with a history of substance abuse). Based on clinical experience, gabapentin (Neurontin) is sometimes prescribed by psychiatrists to treat anxiety on an as-needed basis when benzodiazepines are contraindicated. Of note, the placebo response for medications used to treat GAD and PD is high. 13

PSYCHOTHERAPY AND RELAXATION THERAPIES

Psychotherapy includes many different approaches, such as cognitive behavior therapy (CBT) and applied relaxation ( Table 5 ) . 33 , 34 CBT may use applied relaxation, exposure therapy, breathing, cognitive restructuring, or education. Psychotherapy is as effective as medication for GAD and PD. 11 Although existing evidence is insufficient to draw conclusions about many psychotherapeutic interventions, structured CBT interventions have consistently proven effective for the treatment of anxiety in the primary care setting. 34 – 36 Psychotherapy may be used alone or combined with medication as first-line treatment for PD 37 and GAD, 11 based on patient preference. Psychotherapy should be performed weekly for at least eight weeks to assess its effect.

Mindfulness has similar effectiveness to traditional CBT or other behavior therapies, 38 particularly mindfulness-based stress reduction. 39 A meta-analysis of 36 randomized controlled trials on meditation showed that meditative therapies reduce anxiety symptoms, but most studies looked at anxiety symptoms rather than anxiety disorders. 40 Transcendental meditation has similar effectiveness to other relaxation therapies. 41

After a treatment course, rebound symptoms may occur less often with psychotherapy than with medications. Successful treatment requires tailoring options to individuals and may often include a combination of modalities. 11 , 37 , 42 Combined treatment with medications and psychotherapy reduces relapse even at two years. 43

COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES

Although a number of complementary and alternative products have evidence for treating depression, most lack sufficient evidence for the treatment of anxiety. Botanicals and supplements sometimes used to treat GAD and PD are listed in Table 6 . Kava extract is an effective treatment for anxiety 44 ; however, case reports of hepatotoxicity have decreased its use. 45 St. John's wort, tryptophan, 5-Hydroxytryptophan, and S-adenosyl-l-methionine should be used with caution in combination with SSRIs because of the increased risk of serotonin syndrome. 46

Evidence indicates that music therapy, aromatherapy, acupuncture, and massage are helpful for anxiety associated with specific disease states, but none have been evaluated specifically for GAD or PD.

Referral and Prevention

For patients with GAD or PD, psychiatric referral may be indicated if there is poor response to treatment, atypical presentation, or concern for significant comorbid psychiatric illness. There is insufficient evidence to support a concise recommendation on the prevention of PD and GAD in adults.

Data Sources : We searched Essential Evidence Plus, PubMed, and Ovid Medline using the keywords generalized anxiety disorder, panic disorder, diagnosis, treatment, medication, epidemiology, etiology, pathophysiology, differential diagnosis, and complementary and alternative medicine. We searched professional and authoritative organizations on the topic of anxiety disorders, including the American Psychological Association, the National Institute of Mental Health, the National Institute for Health and Care Excellence, and the Cochrane Collaboration. Search dates: May to July 2014.

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Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28.

Chugh-Gupta N, Baldassarre FG, Vrkljan BH. A systematic review of yoga for state anxiety: considerations for occupational therapy. Can J Occup Ther. 2013;80(3):150-170.

Otto MW, Tuby KS, Gould RA, McLean RY, Pollack MH. An effect-size analysis of the relative efficacy and tolerability of serotonin selective reuptake inhibitors for panic disorder. Am J Psychiatry. 2001;158(12):1989-1992.

Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev. 2003;2:CD003592.

Zohar J, Westenberg HG. Anxiety disorders: a review of tricyclic anti-depressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand Suppl. 2000;403:39-49.

Baldwin D, Woods R, Lawson R, Taylor D. Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis. BMJ. 2011;342:d1199.

Ravindran LN, Stein MB. The pharmacologic treatment of anxiety disorders: a review of progress. J Clin Psychiatry. 2010;71(7):839-854.

Carter NJ, McCormack PL. Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs. 2009;23(6):523-541.

Chessick CA, Allen MH, Thase M, et al. Azapirones for generalized anxiety disorder. Cochrane Database Syst Rev. 2006;3:CD006115.

Imai H, Tajika A, Chen P, et al. Azapirones versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2014;9:CD010828.

Wiseman CN, Gören JL. Does bupropion exacerbate anxiety?. Curr Psychiatry Rep. 2012;11(6):E3-E4.

Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ. 2014;348:g1996.

Furukawa TA, Streiner DL, Young LT. Antidepressant plus benzodiazepine for major depression. Cochrane Database Syst Rev. 2001;2:CD001026.

Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ. 2012;345:e7500.

Depping AM, Komossa K, Kissling W, Leucht S. Second-generation antipsychotics for anxiety disorders. Cochrane Database Syst Rev. 2010;12:CD008120.

Guaiana G, Barbui C, Cipriani A. Hydroxyzine for generalised anxiety disorder. Cochrane Database Syst Rev. 2010;12:CD006815.

National Institutes of Health. What is anxiety disorder? Treatments. http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part6 . Accessed August 1, 2014.

Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57(1):35-43.

Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev. 2007;1:CD001848.

Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med. 2010;8:38.

Furukawa TA, Watanabe N, Churchill R. Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database Syst Rev. 2007;1:CD004364.

Khoury B, Lecomte T, Fortin G, et al. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763-771.

Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. J Psychiatr Pract. 2012;18(4):233-252.

Chen KW, Berger CC, Manheimer E, et al. Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2012;29(7):545-562.

Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006;1:CD004998.

Pull CB. Combined pharmacotherapy and cognitive-behavioural therapy for anxiety disorders. Curr Opin Psychiatry. 2007;20(1):30-35.

Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67.

Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database Syst Rev. 2002;2:CD003383.

Rowe A, Ramzan I. Are mould hepatotoxins responsible for kava hepatotoxicity?. Phytother Res. 2012;26(11):1768-1770.

Sarris J. St. John's wort for the treatment of psychiatric disorders. Psychiatr Clin North Am. 2013;36(1):65-72.

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Anxiety Disorders by Jeannette M. Reid , Dean McKay LAST REVIEWED: 05 December 2016 LAST MODIFIED: 22 April 2013 DOI: 10.1093/obo/9780199828340-0006

Recent epidemiological research has shown that anxiety disorders, collectively, are the most common set of psychiatric disorders. Lifetime prevalence estimates suggest that nearly 30 percent of the population will experience an anxiety disorder at some point in their life ( Kessler, et al. 2005 , cited under Phobias ). Bolstering the concern, anxiety disorders (as a group) tend to be associated with a host of cognitive impairments (e.g., perseveration, visual memory deficits), diminished quality of life (e.g., in areas of work and social functioning), and both psychiatric and medical comorbidities. Anxiety disorders may be roughly classed into two groups: (1) those characterized primarily by acute fear (e.g., phobias) and (2) those associated with lower level, but chronic, anxiety and apprehension (with the clearest example being generalized anxiety disorder). Cognitive and behavioral explanations of anxiety predominate, with related treatments showing most consistent research support among psychosocial interventions. (While standard pharmacological practices are mentioned wherever relevant, a more in-depth discussion of pharmacological interventions for anxiety disorders is outside the scope of this chapter.) In general, the etiology of anxiety disorders is likely best understood through the lens of the diathesis-stress model—such that individuals have a genetic predisposition/vulnerability and situational factors mediate symptomatology. (Certainly, a sudden expression of symptoms following brain damage would be an exception. However, as these presentations—albeit fascinating—are in the minority, a related discussion will be beyond the scope of this bibliography.) Within this article, the following anxiety disorders will be discussed in detail: phobias, panic with and without agoraphobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Factors of current interest in the field will be attended to specifically—for instance, comorbidity in obsessive-compulsive disorder and differential risk in posttraumatic stress disorder. Throughout the discussion, pertinent works will be delineated and summarized.

The following works have been selected for both their breadth and the authors’ prominence in the field. Barlow 2002 provides an in-depth review of classification, presentation, etiology, assessment, and treatment of all anxiety disorders that appear in the Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Theories of fear acquisition (e.g., evolutionary) are assessed by Ollendick and King 1991 and by Ohman 2009 . Borkovec’s is the most frequently cited name in GAD (generalized anxiety disorder) for his research in developing a comprehensive model of the condition and the underlying primary mechanism: worry. This has led to considerable research on worry; accordingly, two of Borkovec’s most frequently cited works have been selected— Borkovec 1994 and Borkovec, et al. 1991 . Finally, we recommend the comprehensive work by Antony and Stein 2008 for information on biological bases of various anxiety disorders.

Antony, M. M., and M. B. Stein. 2008. Oxford handbook of anxiety disorders . New York: Oxford Univ. Press.

DOI: 10.1093/oxfordhb/9780195307030.001.0001

This book offers comprehensive coverage of the full range of anxiety disorders. Of note, the book includes a chapter on the underlying biological bases of specific anxiety disorders and includes a chapter on the neuroscience of anxiety (i.e., proposed fear circuitry).

Barlow, D. H. 2002. The nature of anxious apprehension. In Anxiety and its disorders: The nature and treatment of anxiety and panic . 2d ed. Edited by D. H. Barlow, 64–104. New York: Guilford.

Barlow reviews his fundamental conceptualization of anxiety as a “sense of uncontrollability focused largely on possible future, threat, danger, or other potentially negative events” (p. 64)—a state that appears to require both cognitive and physical hypervigilance. This chapter, as well as the book as a whole, is one of the most frequently cited sources on anxiety disorders and covers the full range of theory and phenomenology of anxiety experiences.

Borkovec, T. D. 1994. The nature, functions, and origins of worry. In Worrying: Perspectives on theory, assessment, and treatment . Edited by G. Davey and F. Tallis, 5–33. New York: Wiley.

Borkovec reviews theoretical perspectives on worry’s origins as well as physiological correlates to the common experience of worry. Given the central role worry occupies in many anxiety disorders, this chapter is important in the foundations of understanding this specific cognitive feature.

Borkovec, T. D., R. Shadick, and M. Hopkins. 1991. The nature of normal and pathological worry. In Chronic anxiety: Generalized anxiety disorder, and mixed anxiety depression . Edited by R. M. Rapee and D. H. Barlow, 29–51. New York: Guilford.

Borkovec is the leading name in research on generalized anxiety disorder. In this chapter, he and colleagues offer distinctions between typical and pathological (i.e., functional and dysfunctional) worry. This chapter sets the stage for establishing the distinct nature of worry in psychopathology as compared to everyday worry. In light of the ubiquity of worry, setting out the boundaries for how to distinguish normal from abnormal worry is an important conceptualization.

Ohman, A. 2009. Of snakes and faces: An evolutionary perspective on the psychology of fear. Scandinavian Journal of Psychology 50:543–552.

DOI: 10.1111/j.1467-9450.2009.00784.x

Ohman reviews an evolutionary perspective of fear via literature on differential fear conditioning, quicker nonconscious processing, and enhanced attention toward both snakes and threatening faces when compared to neutral stimuli. There has been considerable interest in the basic evolved nature of fear. Of particular interest has been the way in which this information is processed, and Ohman provides an extensive analysis of cognitive processing of fear.

Ollendick, T. H., and N. J. King. 1991. Origins of childhood fears: An evaluation of Rachman’s theory of fear acquisition. Behaviour Research and Therapy 29:117–123.

Ollendick and King examine the extent to which childhood fear onset can be attributed to indirect sources of learning (i.e., vicarious and instructional factors) versus direct conditioning. Childhood anxiety is of generalized importance since the developmental features of anxiety set the stage for treatment across all ages. The etiological theory of anxiety is described and evaluated in the context of Rachman’s theory, an important model of anxiety acquisition.

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“Okay, we need to figure this out”: Exploring the Impact of a Generalized Anxiety Disorder Diagnosis on Relational Turbulence and Satisfaction in the Romantic Relationships of Emerging Adults Public Deposited

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The purpose of this project was to examine the impact of a generalized anxiety disorder diagnosis in the romantic relationships of emerging adults. By applying the Relational Turbulence Model (RTM), my goal was to uncover how relational confidence and partner interference were affected by the diagnosis as a turbulent event. After conducting 12 in-person interviews with individuals who had been diagnosed with anxiety in their romantic relationships, a few key themes emerged. My findings indicate that most couples had different relational satisfaction levels post-diagnosis. Additionally, participants who reported higher relational confidence levels post-diagnosis were able to maintain their relationships, while those who reported lower confidence ultimately broke up with their partners. If partners were supportive post-diagnosis, relational satisfaction grew. However, if partners were perceived as not being supportive, relational satisfaction often went down. Couple communication styles fell into one of two categories: Open communication or guarded communication. Other patterns indicated that when describing relationships, many participants used catastrophic language and metaphors. These findings support previous literature that explored interactions between turbulent events, relational confidence, and partner interference. Ultimately, this study contributes new knowledge to the realm of mental health as it is applied to the Relational Turbulence Model.

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351 Anxiety Research Topics & Essay Titles (Argumentative, Informative, and More)

According to statistics, approximately 40 million people in the United States struggle with anxiety disorders, constituting 19.1% of the population. Generalized anxiety disorder is a condition that is characterized by an excessive and constant feeling of worry about everyday things. Open conversations about anxiety help reduce the stigma associated with mental health issues. Moreover, it is a good way to educate people about the condition, its causes, symptoms, impact, and available treatments.

In this article, we’ll introduce 351 anxiety topics you can use for your essay or research paper ! Keep reading to find out more.

🔝 Top 12 Anxiety Essay Topics

📝 Anxiety Essay Prompts

🔍 anxiety research topics, 🤓 anxiety essay titles.

📕 Essays on Anxiety: Guide

🔗 References

🔝 top 12 anxiety topics to write about.

Types of anxiety disorders.
Anxiety: Causes and treatment.
How to deal with anxiety?
Is there a connection between anxiety and depression?
What are treatments for anxiety?
Anxiety disorders in children.
Physical symptoms of anxiety.
Antidepressants as a way to overcome anxiety.
Risk factors of anxiety.
Symptoms of anxiety in teenagers.
How do you prevent anxiety?
Social anxiety disorder: My experience.

The picture provides ideas for a research paper about anxiety.

Have trouble writing a paper about anxiety disorder and related topics? Don’t worry—we’ve prepared some essay prompts to help you get an A for your writing assignment!

Social Anxiety Essay Prompt

Social anxiety disorder, formerly known as social phobia, is characterized by a persistent fear of being in unfamiliar social settings. It usually begins in youth and influences an individual’s adult life. In your essay on social anxiety, you may touch on the following aspects:

Causes and risks of social anxiety.
The main symptoms of social anxiety.
Social anxiety in children and teenagers.
Ways to prevent or overcome social anxiety.
Available treatments for social anxiety.

Speech Anxiety Essay Prompt

Most people feel anxious when they have to present a speech in front of an audience. Even trained public speakers may experience anxiety before delivering a speech. People who look confident and relaxed while talking to an audience have mastered managing their feelings and using them to their advantage. While discussing speech anxiety, try finding answers to the following questions:

What are the symptoms of speech anxiety?
Why do people get nervous in front of an audience?
What can help to overcome speech anxiety?
Why does exercising help in reducing stress and anxiety?

Test Anxiety: Essay Prompt

It’s common for college students to feel anxious before exams. Yet, significant anxiety and stress before and during an important exam might have negative consequences. In your essay on test anxiety, you can provide detailed information on how to deal with it based on the tips listed below:

Prepare for the test.
Use study strategies to understand and remember your course material better.
Take care of your physical health.
Surround yourself with things that calm you.
Talk with your teacher to know what to expect from the exam.

Overcoming Anxiety: Essay Prompt

Anxiety can stem from factors such as genetics, personality traits, and life experiences. Although psychotherapy and medication are often necessary for individuals with anxiety disorders to manage their emotional well-being, incorporating lifestyle adjustments and daily routines can also be beneficial. Consider centering your essay on practical daily actions that can help alleviate stress:

Set goals to accomplish.
Communicate with people.
Stop smoking and reduce your consumption of caffeinated beverages.
Solve any of your financial issues.
Dedicate more time to your hobbies.
Have some relaxation time .
Identify and try to avoid your anxiety triggers.
How is daily yoga effective for reducing anxiety?
Does ethnicity and socioeconomic status have an effect on anxiety prevalence?
Anxiety and acute pain related to the loss of vision .
Divorce is the leading cause of children’s anxiety.
The relation between the COVID-19 pandemic and increased anxiety rates.
The impact of immigration on the growth of anxiety cases in society.
The efficiency of open communication in overcoming anxious well-being.
The efficacy of iron supplementation to reduce vulnerability to anxiety in women with heavy menses .
Emotional issues anxiety causes and ways to cope with them.
How does anxiety contribute to drug, alcohol, and nicotine consumption?
The factors that provoke anxious states in college students.
Generalized anxiety disorder in college students and potential treatment .
Children and adolescents: age’s impact on increasing anxiety risks.
The connection between anxiety disorder and fear.
Stress at the workplace is a key provoker of anxiety in the 21st century.
Frontline nurses’ burnout, anxiety, depression, and fear statuses .
Triggers : the importance of finding causes of anxiety.
The impact of anxiety on social relations with friends and relatives.
The peculiarities of anxiety states in teenagers in high school.
Anxiety as a result of perfectionism and fear of failure.
Symptoms of anxiety, depression, and peritraumatic dissociation .
The influence of anxiety on public speaking skills.
Cultural differences in the expression and perception of anxiety.
Psychological aspects of anxiety in situations of crisis.
Digital detox is an effective method of anxiety reduction.
The correlation between discrimination/prejudice and depression/anxiety .
The relationship between social isolation and the development of anxiety disorders.
Death anxiety: methods and strategies how to cope with the disorder.
Quantitative properties of anxiety: magnitude and tone.
The impact of economic instability on the level of anxiety in society.
Evidence-based interventions for anxiety disorders .
The types of anxiety disorder and their peculiarities.
The key characteristics of anxiety disorder.
The role of family relationships in the development of anxiety disorders.
The symptoms of anxiety and ways to identify them at an early stage.
Anxiety disorder treatment in an Afro-American boy .
Psychological aspects of anxiety in adapting to a new culture or society.
The relationship between the quality of sleep and the level of anxiety.
Social media is a trigger of anxiety in the digital world.
The role of gender stereotypes in the formation of anxiety in men and women.
Depression and anxiety among college students .
Anxiety is a result of the rapidly changing information society.
The influence of literature on the perception of anxiety.
Psychological fitness and its effectiveness in reducing anxiety.
The use of therapy platforms in decreasing anxiety.
Anxiety of musicians in music performance .
Cyberbullying as a reason for emotional distress and anxiety.
The role of childhood experiences in the development of anxiety later in life.
Introversion and its contribution to a constant state of anxiety.
The influence of religious and cult practices on reducing anxiety.
Case studies of patients with anxiety and mood disturbances .
The risk factors of anxiety in children with disabilities.
Videogames are a key trigger of anxiety development.
Mindful breathing strategy and its importance for reducing anxiety.
The impact of psychological trauma on the development of chronic anxiety.
Abnormal psychology: anxiety and depression case .
Government support for mental health policy to reduce anxiety in the UK.
The influence of ambition and high expectations on the level of anxiety.
Managing anxiety in evidence-based practice .
Political conflicts and their impact on the level of anxiety in society.
The role of social support in managing and reducing anxiety.
Anxiety and decision-making: literature review .
Anxiety as a result of low self-esteem and problems with self-acceptance.
The role of meditation and mental practices in anxiety management.

Social Anxiety Research Paper Topics

Genetics is a leading cause of social phobia .
The effects of social anxiety on professional and career development.
Social anxiety disorder: diagnosis and treatment .
Empathy and social anxiety: how understanding the feelings of others affects one’s own anxiety.
The evidence-based pharmacotherapy of social anxiety disorder.
The physical symptoms of social anxiety disorder.
Prevalence rates of social anxiety disorder across different cultures.
The impact of cultural factors on the development of social anxiety disorder.
The public speaking anxiety analysis .
Neural mechanisms that contribute to the resistance of social anxiety disorder.
The potential of utilizing biomarkers to improve social anxiety treatments.
The effective methods of anxiety disorder prevention.
Cultural and social aspects of social anxiety: peculiarities and coping methods.
The negative social experience is a trigger to social phobia.
High anxieties: the social construction of anxiety disorders .
Brain areas involved in the development of social anxiety.
The peculiarities of treatment of social anxiety at an early age.
Social anxiety at school or workplace: a way to overcome the phobia.
Inclusive school environments as a way to support students with social anxiety.
The role of self-esteem in the experience of social anxiety.
School phobia: the anxiety disorder .
The impact of social anxiety disorder on romantic relationships .
The efficiency of technology-based interventions in the treatment of social anxiety.
Social anxiety: Is there a way to overcome the fear of public speaking?
The connection between social anxiety and fear of evaluation by others.
Social anxiety and its consequences on cognitive processes .
Social anxiety disorder and alcohol abuse in adolescents .
The criteria for diagnosing social anxiety disorder.
The role of parental expectations and pressure in the formation of social anxiety.
Why do females more often experience social anxiety disorder than males?
Social anxiety disorder is one of the most common anxiety disorders worldwide.
Social aspects of depression and anxiety .
Avoidance of social situations is a key symptom of social phobia.
The influence of social anxiety on the expression of creativity and creative potential.
Social anxiety and its consequences on the quality of life in adolescents.
Metacognitive processes in the maintenance of chronic social anxiety.

Research Questions about Anxiety

How does anxiety affect the body’s immune system ?
What are the peculiarities of the treatment of anxiety at a young age?
Is acceptance and commitment therapy effective in fighting anxiety ?
How are inflammatory processes in the body related to anxiety disorders?
What is the relationship between anxiety and gastrointestinal disorders?
What effect does anxiety have on the cardiovascular system?
What role do neurotransmitters like serotonin and GABA play in regulating anxiety?
What are the stress and anxiety sources amongst students?
How does genetics influence the likelihood of gaining medical anxiety disorders?
What is the effectiveness of cannabis in treating anxiety disorders?
How do gastrointestinal microbiota imbalances affect anxiety levels?
How can specific allergies or sensitivities lead to increased anxiety?
How does chronic anxiety disorder affect cortisol levels?
How is emotion regulation therapy used for generalized anxiety disorder ?
What role may neuroimaging play in understanding communicative anxiety disorders?
How is anxiety diagnosed in people with disabilities?
How does anxiety disorder depend on a person’s eating habits ?
What are the effects of nootropics in treating anxiety disorders?
What are the ways of managing general anxiety disorder in primary care ?
Why is family support an important part of the anxiety treatment?
How do gender differences affect the manifestation of anxiety disorders?
What are the effective methods of preventing anxiety disorder?
How does post-traumatic stress disorder contribute to the development of anxiety?
How do doctors differentiate anxiety symptoms from signs of other medical conditions?
How does standardized testing affect an individual with test anxiety ?
What is the impact of chronic illnesses on the development of anxiety?
How does alcohol impact an increasing level of anxiety?
What methods of diagnosing anxiety disorders exist in medicine?
Why certain medical conditions can trigger symptoms of anxiety?
What is the role of emotional intelligence in overcoming social anxiety?
What is the relationship between child maltreatment and anxiety ?
How did COVID-19 contribute to increased anxiety among people in the US?
How effective is psychopharmacology in treating social anxiety?
What are the most common physical symptoms of anxiety in children?
How do sleep disorders provoke social anxiety?
What are the long-term effects of chronic anxiety on human health?
How can parents and teachers release anxiety in children ?
How can medical surgery affect anxiety levels in patients?
How do hormonal imbalances contribute to heightened anxiety?
What is the best way of treating adults with anxiety?
Why benzodiazepines and SSRIs are often used in anxiety treatment?
What brain areas are involved in the development of anxiety disorder?
What is the holistic approach to anxiety disorder ?
How can virtual reality simulation treatment help with medical anxiety?
Anxiety disorder and its risk factors.
Why does physical exercise positively impact social anxiety treatment?
What advice are most often given by psychologists for the prevention of anxiety?
Is depression and anxiety run in the family ?
How can targeted medication improve the effect of psychotherapy in anxiety disorders?

Argumentative Essay Topics about Anxiety

Social anxiety disorder is highly comorbid with other psychiatric disorders.
Is anger the side effect of anxiety?
Social media: the rise of depression and anxiety .
Women are twice as likely as men to develop anxiety disorder.
Breathing into a brown paper bag decreases the level of anxiety.
Educational institutions should support students with anxiety symptoms.
Social networks contribute to the development of anxiety.
Summarizing and evaluating the concept of anxiety .
Is virtual reality exposure therapy effective in treating anxiety-related conditions?
Dismissing someone’s anxiety exacerbates the problem.
Negative thinking is a serious anxiety trigger.
Do certain cultural customs impact how anxiety is expressed and handled?
Social support plays a vital role in treating anxiety disorders.
Overcoming separation anxiety in children .
People with anxiety disorder should seek professional help.
Employers should provide flexible work schedules for workers with anxiety disorders.
Anxiety disorder increases the risk of health complications.
Does anxiety create problems in relationships?
Anxiety often causes or triggers depression .
Adult depression and anxiety as a complex problem .
Academic pressures can contribute to anxiety in young individuals.
Parents should control the social media usage of their children to protect them from anxiety.
Is social isolation a contributing factor to the development of anxiety in older adults?
Perfectionism is a personality trait that often correlates with increased anxiety levels.
Overcoming anxiety leads to personal growth and increased resilience.
The anxiety related to the COVID-19 virus uncertainty: strategy .
Anxiety hinders an individual’s ability to concentrate and make decisions.
Are anxiety disorders the most common mental disorders in the modern world?
The constant state of alertness in anxiety leads to mental exhaustion and burnout.
Anxiety disorder is a leading cause of tension headaches.
Political upheavals increase collective anxiety on a societal level.
Cognitive-behavioral therapy for generalized anxiety disorder and depression .
A family history of mental health issues is a spread cause of anxiety.
Do smartphone notifications contribute to technology-induced anxiety?
Regular exercising helps decrease symptoms of anxiety.
Workplace support is critical for persons dealing with anxiety at work.
Excessive use of social media contributes to heightened anxiety levels.
Effective art therapies to manage anxiety .
Should workplaces implement mental health programs to reduce employee anxiety?
People with anxiety disorder should do regular follow-up sessions to monitor their condition.
Do financial concerns trigger the development of anxiety?
Stigma prevents individuals with anxiety from seeking help.
Is social anxiety more spread with a strong emphasis on individual achievements?
General anxiety disorder treatment plan .
Do genetic factors play a role in predisposing individuals to anxiety disorders?
Love from friends and family is the best treatment for anxiety disorder.
Telling other people about your anxiety is one of the most uncomfortable things.
Caffeine use increases the severity of anxiety symptoms.

Anxiety Essay Topics for Informative Papers

The major symptoms and signs of social anxiety disorder.
What is generalized anxiety disorder (GAD)?
Anxiety disorders, their definition, and treatment .
The effective methods of coping with separation anxiety disorder.
The important takeaways about pathological anxiety.
Dos and don’ts for overcoming post-argument anxiety.
Coping with anxiety in romantic relationships.
Anxiety: advanced assessment of a patient .
What are the peculiarities of social anxiety disorder?
Cognitive behavioral therapy is effective in treating people who feel anxious.
The strategies for alleviating anxiety in your pets.
Seven things you can do to help your friend cope with anxiety.
Anxiety disorders: diagnoses and treatment .
What are the risk factors for anxiety in children and adults?
The characteristics of high-functioning anxiety.
Cognitive Behavioral Therapy (CBT) for anxiety disorders: How it works.
The main causes of generalized anxiety disorder (GAD).
“Depression, Anxiety, and Stress in Diabetes” by Chlebowy .
What are the methods of treating anxiety in old age?
The importance of early intervention: how to prevent anxiety in children.
What does anxiety disorder feel like?
The value of stress management skills in preventing anxiety.
Generalized anxiety disorder and its prevalence .
The benefits anxiety disorder can bring.
How can antidepressants aid in coping with anxiety disorder?
Self-guidance: how to prevent an anxiety attack.
The genetic and hereditary factors that contribute to anxiety disorders.
Dual diagnosis: anxiety disorders & developmental disabilities .
How small acts of kindness can help with anxiety?
Psychological strategies to reduce general anxiety and stress.
How do you understand that you need assistance in coping with anxiety?
Foods that can help reduce anxiety.
Anxiety disorders: cognitive behavioral therapy .
The effective methods of coping with anxiety in learning a new language.
Top 12 ways to reduce the risk of anxiety disorders.
The power of yoga and meditation in managing anxiety.
How friends and family can provide support to someone with anxiety?
What is the anxiety?
The troubling link between domestic violence and anxiety .
Finding a good anxiety therapist: methods and strategies.
How does anxiety affect teenagers in high school?
The main types of anxiety and their peculiarities.
Anxiety disorder and its characteristics .
How do you prepare yourself to better handle anxiety-provoking situations?
The power of positive thinking in overcoming anxiety.
The effective ways of dealing with an anxious mindset at work.
Coping with anxiety on your own: The possible consequences.
Fight-or-flight response in anxiety disorders .
Famous people with high-functioning anxiety.
How can a regular sleep pattern protect you from anxiety development?

Anxiety Title Ideas for Cause-and-Effect Essays

Muscle aches and breathing problems are the short-term effects of anxiety.
Why does anxiety provoke memory issues?
Effects of anxiety and ways to conquer it .
Increased risk of developing migraines and headaches in people with anxiety.
The role of chronic stress and traumatic events in the development of anxiety.
Genetic links that increase a person’s risk of developing an anxiety disorder.
What are psychosomatic manifestations of anxiety and their impact on the body?
Substance abuse is a leading cause of anxiety.
Generalized anxiety disorder’s impact on youth .
The problems in interpersonal relationships are due to anxiety.
Loss of a loved one and its impact on the development of anxiety.
Are nail biting or skin picking the first signs of anxiety?
Childhood experiences can cause the onset of anxiety disorders.
What is the effect of anxiety on the nervous system and its functioning?
DSM-5 anxiety disorders: causes and treatment .
The key triggers of anxiety and their impact on a person’s overall well-being.
The butterfly effect of anxiety: how small symptoms can become a disaster.
Does a family history of anxiety disorder make you more prone to this disease?
The physical consequences of anxiety: nausea, muscle tension, and fatigue.
Reaction to stress: anxiety and yoga .
How do the causes of anxiety change depending on the person’s age?
Persistent and uncontrollable thoughts: how does anxiety impact people?
The causes of anxiety among teachers giving face-to-face lessons.
Chest and back pain are physical symptoms of anxiety.
Relationship issues are the leading causes of anxiety disorder.
The effects of marijuana on people with anxiety .
Neurochemical imbalance and its connection with anxiety.
What are the genetic causes of anxiety?
The role of social media in triggering anxiety disorder.
Migraines and headaches are concomitant manifestations of anxiety.
How can daily tasks become the cause of anxiety?
Anxiety disorders and their influence on daily life .
Substance abuse and its impact on the development of anxious states.
Decreased quality of life in people with anxiety disorders.
The chain reaction of anxiety: From triggers to panic attacks.
Hormonal changes in anxiety states and their impact.
Trouble focusing on tasks due to racing thoughts in people with anxiety disorder.
Causes and effects of anxiety in children .
Procrastination and overthinking as behavioral effects of anxiety.
Suicidal thoughts and their connection with high levels of anxiety.
How does anxiety impact communication and collaboration at work?
Social isolation as a result of anxiety disorders.
Chronic stress is a factor contributing to anxiety disorder.
Anxiety disorder: symptoms, causes, and treatment .
Which social factors contribute to the appearance of anxiety?
The fear of the unknown or unpredictable outcomes is a cause of anxiety.
Why do people with anxiety disorder have problems with concentration and attention?
Sociocultural factors that have an impact on the level of anxiety.

Titles for Anxiety Essays: Compare and Contrast

How are anxiety disorders related to eating disorders like anorexia and bulimia?
Psychotherapy or medication: what works better in treating anxiety?
The behavioral, humanistic, and cognitive approaches to anxiety .
The differences in how anxiety impacts children and adults.
Stigma and shame of anxiety in different cultures.
How do you differentiate anxiety from regular stress?
What is the relationship between anxiety and anger?
Panic attack vs. anxiety attack: key differences.
George Kelly’s personal constructs: threat, fear, anxiety, and guilt .
The peculiarities of anxiety disorder depend on the sexual orientation of the person.
How is panic disorder related to anxiety?
Meditation, prayer, traditional rituals: comparison of spiritual ways of anxiety treatment.
How does the perception of anxiety differ in the US and Japan?
Anxiety vs. post-traumatic stress disorder: main common features.
The relationship between anxiety and sleep disorders .
How does anxiety differ from stress in terms of physiological responses?
The differences in anxiety symptoms in people of different ages.
Developmental perceptions of death anxiety .
How can gender-related cultural norms influence how anxiety is expressed?
Aspects of anxiety: psychological and physiological sides.
How does anxiety differ from schizophrenia ?
The comparison of social and generalized anxiety.
Historical views on anxiety: antique and modern times.
The difference in how anxiety affects females and males.
What do anxiety and obsessive-compulsive disorder have in common?
Anxiety and depression during childhood and adolescence .
Anxiety treatment: self-help resources or support groups.
The comparison of biological mechanisms activated during fear and anxiety states.
The cultural differences of anxiety perception: Nigeria vs. Sweden.
Anxiety and bipolar disorder and their main differences.
The effective methods of coping with anxiety: yoga or antidepressants.
What are the cultural differences in anxiety expression?
Anxiety in first-world countries or developing nations.
The differences in help-seeking behavior in people of different religions.
The peculiarities of treatment anxiety in Australia and the United Kingdom.
How is anxiety connected to eating disorders?
Anxiety in veterans vs. civilians: key differences.
How does anxiety management differ from anxiety prevention?
Physical and mental anxiety consequences and their comparison.
How is anxiety described in different academic disciplines?
The manifestation of anxiety in different mental health disorders.
How does anxiety in parents are similar to the one that children have?
Anxiety in urban and rural environments: Key triggers.
The comparison of genetic and environmental factors of anxiety.

📕 How to Write Essays on Anxiety

Need to write an essay on anxiety but don’t know where to start? Let us help you! We’ve prepared detailed instructions that will help you structure your paper.

Anxiety Essay Introduction

An essay’s introduction aims to provide the reader with a clear idea of the essay’s topic, purpose, and structure. It serves as a roadmap for what the paper will cover. To write an introduction, follow these steps:

Grab readers’ attention with a hook .
Introduce the theme or issue you will be discussing.
Provide some background information.
Create a thesis statement.

Hook: According to the National Institute of Mental Health, public speaking anxiety, or glossophobia, affects approximately 40% of the population.

Background information: A fear of public speaking is classified as a social anxiety disorder characterized by shaking, sweating, dry mouth, rapid heartbeat, and squeaky voice.

Anxiety Essay Thesis

A thesis statement is often a sentence in the first paragraph of an essay that summarizes the paper’s main idea. Several tips can assist you in creating a strong thesis statement :

Be specific.
Build a strong argument.
Make your thesis statement arguable.
Provide evidence.
Be clear and concise.

Thesis statement: Although fully overcoming speech anxiety may be impossible, employing various strategies can help manage and harness it for personal growth and success.

Essay about Anxiety: Body Paragraphs

Body paragraphs in an essay develop, support, and elaborate on the thesis statement or argument presented in the introduction, offering evidence, examples, and explanations. They provide the substance and structure that make the essay’s ideas clear and convincing to the reader.

There are several components that each paragraph of the main body needs to include:

Topic sentence.
Supporting evidence.
Detailed explanation of the main points.
Transition to the next paragraph.

Topic sentence: Deep breathing techniques can effectively alleviate pre-performance anxiety, particularly before public speaking engagements.

Supporting evidence: Practicing slow, deep diaphragmatic breathing helps activate the relaxation response. Additionally, deep breathing increases oxygen supply to the cerebral cortex, responsible for cognitive functions and conscious thought processes.

Anxiety Essay Conclusion

The conclusion is an essential component of your essay. It allows you to encourage your readers to consider the implications and solutions to an issue. A strong essay conclusion should do the following:

Restate the thesis.
Summarize the main points.
Provide a clear context for your argument.

Rephrased thesis: Though completely overcoming speech anxiety is challenging, using different strategies can help control it and benefit personal growth and success.

Summary : In conclusion, nobody is perfect, and even seasoned speakers make errors in public speaking. Instead of pressuring yourself to deliver a flawless speech, it’s essential to remember that minor mistakes won’t detract from your overall presentation.

We hope that you’ve found our article helpful! If so, feel free to share it with your friends and leave a comment below.

Thesis Statements; The Writing Center • University of North Carolina at Chapel Hill
How to Write a Five-Paragraph Essay, With Examples | Grammarly
How To Write a Good Essay Introduction in 4 Simple Steps | Indeed.com
Conclusions | Harvard College Writinf Center
Paragraphs; Topic Sentences: Writing Guides: Writing Tutorial Services: Indiana University Bloomington
Anxiety Disorders – National Institute of Mental Health

434 Depression Essay Titles & Research Topics: Argumentative, Controversial, and More

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Home — Essay Samples — Nursing & Health — Anxiety Disorder — The Issue of Generalized Anxiety Disorder

The Issue of Generalized Anxiety Disorder

Categories: Anxiety Anxiety Disorder

About this sample

Words: 2718 |

14 min read

Published: Aug 16, 2019

Words: 2718 | Pages: 6 | 14 min read

Works Cited

American Psychological Association. (2018). Cognitive Behavioral Therapy.
Anxiety and Depression Association of America. (n.d.). Generalized Anxiety Disorder (GAD).
Harvard Health Publishing, Harvard Medical School. (2011). Generalized anxiety disorder. https://www.health.harvard.edu/staying-healthy/generalized-anxiety-disorder
Mayo Clinic Staff. (2020). Generalized anxiety disorder. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803
National Institute of Mental Health. (2020). Generalized Anxiety Disorder. https://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics, 33(3), 557-577.
Perna, G., & Caldirola, D. (2015). The role of cognitive-behavioral therapy in the management of anxiety disorders. Journal of Psychopathology, 21(4), 343-350.
Rickels, K., Etemad, B., & Khalid-Khan, S. (2015). A double-blind, randomized, placebo-controlled trial of flexible-dose escitalopram and paroxetine in the treatment of patients with generalized anxiety disorder. Depression and Anxiety, 32(8), 570-579.
Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9(1), 54-68.

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Open access
Published: 29 March 2024

Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder

Jiaxi Peng 1 na1 ,
Shuai Yuan 2 na1 ,
Zihan Wei 3 na1 ,
Chang Liu 4 ,
Kuiliang Li 5 ,
Xinyi Wei 6 ,
Shangqing Yuan 7 ,
Zhihua Guo 8 ,
Tingwei Feng 8 ,
Yu Zhou 9 , 10 ,
Jiayi Li 9 , 10 ,
Qun Yang 8 ,
Xufeng Liu 8 ,
Shengjun Wu 8 &
Lei Ren 9 , 10

BMC Psychiatry volume 24 , Article number: 241 ( 2024 ) Cite this article

99 Accesses

Metrics details

A temporal network of generalized anxiety disorder (GAD) symptoms could provide valuable understanding of the occurrence and maintenance of GAD. We aim to obtain an exploratory conceptualization of temporal GAD network and identify the central symptom.

A sample of participants ( n = 115) with elevated GAD-7 scores (Generalized Anxiety Disorder 7-Item Questionnaire [GAD-7] ≥ 10) participated in an online daily diary study in which they reported their GAD symptoms based on DSM-5 diagnostic criteria (eight symptoms in total) for 50 consecutive days. We used a multilevel VAR model to obtain the temporal network.

In temporal network, a lot of lagged relationships exist among GAD symptoms and these lagged relationships are all positive. All symptoms have autocorrelations and there are also some interesting feedback loops in temporal network. Sleep disturbance has the highest Out-strength centrality.

Conclusions

This study indicates how GAD symptoms interact with each other and strengthen themselves over time, and particularly highlights the relationships between sleep disturbance and other GAD symptoms. Sleep disturbance may play an important role in the dynamic development and maintenance process of GAD. The present study may develop the knowledge of the theoretical model, diagnosis, prevention and intervention of GAD from a temporal symptoms network perspective.

Peer Review reports

Generalized anxiety disorder (GAD) is a chronic anxiety disorder characterized by excessive and uncontrollable worry. It is quite typical for GAD to be accompanied by other non-specific psychological and physical symptoms [ 1 ]. According to a global epidemiological study, the combined lifetime prevalence of GAD is 3.7% [ 2 ]. GAD patients often suffer from severe functional impairments and have high rates of psychiatric comorbidities (e.g., major depressive disorder) [ 2 ]. Although pharmacotherapies and psychotherapies can effectively alleviate the symptoms of GAD in about 50% of the patients, it is still unclear how to treat those patients who partly or even not at all respond to the treatments [ 3 ].

Such disappointments– not uncommon in clinical practices– prompt researchers to move from a static view, where the links between symptoms are at best correlational, to a dynamic view, where the many symptoms related to a certain mental disorder are assumed to interact and co-evolve over time [ 4 ]. This new way of examining the causal relationships between a suite of related psychological symptoms is the core premise of the network approaches to psychopathology [ 5 ]. In essence, network models of symptoms focus on the causal relationships between symptoms and encourage the consideration of how the vicious cycle among symptoms affect the development and maintenance of certain mental disorders [ 4 , 6 , 7 ]. This perspective aligns with contemporary theories of GAD, which emphasize the self-perpetuating nature of its symptoms (through causal relations among symptoms) and how the disorder is reinforced and maintained through feedback loops [ 8 ]. For instance, according to the Metacognitive model (MCM), GAD may be maintained and perpetuated through a series of causal interactions between two types of worry. An individual might initially experience excessive worry about a potential negative outcome (Type 1 worry). This worry could lead to restlessness and muscle tension as the bodily reactions to perceived threats. As this worry persists, the individual begins to worry about the fact that they are always worrying (Type 2 worry) [ 9 ]. They might believe that this uncontrollable worry is harmful and indicative of a lack of mental control, leading to difficulty concentrating and irritability due to the constant self-monitoring and self-criticism. This, in turn, may cause sleep disturbances (worrying at night), leading to fatigue the following day. The fatigue and lack of sleep might then exacerbate the original worry, creating a feedback loop where each symptom feeds into and exacerbates the others. Similarly, according to the Emotion Dysregulation Model, heightened emotional arousal (which is frequently experienced among individuals with GAD) [ 10 ] may lead to irritability, which then triggers excessive worry (as maladaptive attempts to regulate the emotions) and restlessness [ 11 ]. As worry is oftentimes ineffective in managing the negative emotions, individuals may become anxious about their inability to manage the emotions and fuel the negative emotional arousal.

Network analysis offers a powerful tool for visualising and analysing the symptom-symptom interactions and feedback loops proposed in the contemporary theories of GAD. In a network model, each symptom of GAD is represented as a node in a network, and the causal influences between these symptoms are depicted as edges connecting the nodes. This structure allows researchers to directly map and analyse complex feedback loops where symptoms can reciprocally affect and perpetuate each other over time [ 12 ]. For instance, researchers may pinpoint how excessive worry leads to sleep disturbances, which in turn exacerbate fatigue and irritability. These symptoms then feed back into increased worry. This may address the inherent limitations of other modelling techniques based on latent variable frameworks (dynamic structural equation modelling), which often assume a common cause gives rise to symptoms, and by definition, do not contain feedback relations [ 12 ]. By neglecting the possibility of such feedback loops and reciprocal interactions among symptoms, these models potentially oversimplify the mechanistic processes in GAD. Furthermore, network analysis may unfold the most impactful and predominant symptoms underlying a certain mental disorder, and therefore offer clinical guidance for the design of effective treatments: the direct treatment on the most dominant symptom(s) may efficiently decrease or even stop the co-developments of other related symptoms. This view has also received support from empirical analysis: for example, Elliott and colleagues found that the symptoms with the most impact on the symptom network of anorexia nervosa at baseline were also mostly indicative of recovery [ 13 ]. Following this line of reasoning, the network approach is especially attractive for researchers to identify the most significant symptoms for GAD and thereby develop effective interventions.

At present, three studies established the network consisting of only anxiety symptoms [ 14 , 15 , 16 , 17 ] and the most of the anxiety symptom networks are based on anxiety-depression comorbidity [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], or other variables together with anxiety and depression, such as post-traumatic stress disorder [ 30 , 31 ], eating disorder [ 32 , 33 ], somatic symptomatology [ 34 ], intolerance of uncertainty [ 35 ], attention control [ 36 ], emotion regulation [ 37 , 38 ], COVID-19-related variables [ 39 , 40 ]. Most of the aforementioned studies used cross-sectional dataset and considered the cross-sectional design as one of their major limitations, as it failed to manifest temporal dynamic development and maintenance process of GAD symptoms and its results had to be interpreted with due caution. In addition, these networks were based on different questionnaires, such as State-Trait Anxiety Inventory-Trait subscale [ 16 , 21 , 33 ], Generalized Anxiety Disorder 7-Item Questionnaire (GAD-7) [ 14 , 15 , 17 , 20 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 35 , 38 ], and Beck Anxiety Inventory [ 32 , 37 ]. The symptoms based on these questionnaires only partially matches the symptoms diagnostic criteria of GAD based on the Diagnostic and Statistical Manual of Mental Disorders, the fifth Edition (DSM-5) [ 1 ], which is considered as the most definitive manual for diagnosis and treatment. For example, two GAD-7 symptoms (nervousness or anxiety and trouble relaxing) do not map to DSM-5 and four DSM-5 symptoms (being easily fatigued, difficulty concentrating or mind going blank, muscle tension and sleep disturbance) do not exist in GAD-7 [ 1 , 41 ]. The disparities between DSM-5 and the other questionnaires limit the contribution of the aforementioned studies to the diagnosis, prevention and intervention of GAD. To address these limitations, the current study aims to directly assess the symptom network of GAD based on DSM-5 criteria.

The aim of this study is to establish an exploratory empirical conceptualization of temporal networks of GAD symptoms in order to clarify how the symptoms of GAD interact with each other and strengthen themselves over time. To estimate such temporal networks, we employ Experience sampling methodology (ESM) to conduct daily data collection over a period of 50 consecutive days. ESM has been used in investigating temporal dynamics among symptoms of different psychiatric disorders, including PTSD [ 42 ], depression [ 43 ], and eating disorders [ 44 ]. In ESM, some devices, such as handheld computers and smartphones, are often used for repeatedly collecting data from participants’ daily lives [ 45 , 46 ]. This method has many advantages, including higher ecological validity and accuracy, smaller recall bias, and capability to identify changes of variables over time and dynamic relationships among variables [ 45 , 47 ].

The recent innovation of statistical models has enabled the use of network models in the analysis of intensive longitudinal data gathered through ESM [ 48 , 49 ]. Some of these models can be used to analyze data from a single individual (e.g., vector autoregression models; VAR) [ 50 , 51 ], while others are designed for data collected from multiple individuals (e.g., multilevel VAR) [ 48 , 52 , 53 , 54 ]. Of particular importance is the temporal network, which captures lagged relationships between symptoms from one time point (t-1) to the next (t), using Granger causality [ 55 ]. This type of network reveals how symptoms interact with each other and strengthen over time. Moreover, by examining the strength centrality (i.e., Out-strength and In-strength) of symptoms in the temporal network, researches can gain insights into the roles these symptoms play in the dynamic evolution of the symptom network system. The symptom with the highest Out-strength has the best ability to predict other symptoms in the next time point, while the symptom with the highest In-strength is predicted, to the greatest extent, by other symptoms in the previous time point.

In the present study, we estimated a multilevel network model based on daily diary data from individuals with elevated GAD-7 scores (i.e., GAD-7 ≥ 10) in order to investigate how symptoms of GAD, as defined by DSM-5 criteria, interact with each other and strengthen over time. This approach aims to enhance our understanding of the theoretical model, diagnosis, prevention and intervention of GAD from a temporal symptoms network perspective.

Participants and ethical statement

1062 (55% male) undergraduate students from the Fourth Military Medical University voluntarily completed the initial measure of GAD-7, a widely used tool for screening GAD and evaluating its severity [ 41 ]. From these students, 115 potential participants with a sum-score greater than a clinical cut point (GAD-7 ≥ 10 according to Spitzer et al. 2006 [ 41 ] and without medical history of mental disorder were preliminarily selected to take part in our study. We subsequently contacted this target group and informed them of the design and purpose of the subsequent daily diary study. All participants– among them 52% were male - agreed to participate in the study and gave consent for their participations. With an average age of 19.60 (SD = 1.02) and an average year of education amounting to 14.10 (SD = 0.78), participants recorded an average score of 12.16 (SD = 2.46) on the GAD-7.

The independent Ethics Committee, First Affiliated Hospital of Fourth Military Medical University granted ethical approval for the present study (Number: KY20182047-F-1). The daily questionnaire, administrated and collected via Wenjuanxing ( www.wjx.cn ), consisted of 20 items, in which only the first eight items were relevant to our study purpose and hence included in the current analysis. After finishing the questionnaire for each day, participants were given 3 RMB (about 0.4 US dollars) for compensation. Participants who had completed the questionnaire for more than 40 days were rewarded by double compensation. With an average completion of 47.66 days (SD = 4.28 days; range = 27–50) and the fact that no one has filled out the questionnaire for fewer than 25 days, participants were considered mostly cooperative in the current study.

Procedure and measures

The time period of data collection was from June 8th, 2019 to July 26th, 2019. During the investigation, questionnaires were sent to participants at 20:00, with a deadline for responses set at 3 a.m. the next day [ 43 ]. Any data received after the deadline were treated as missing.

In this study, the eight daily self-reported symptoms under investigation are based on the diagnosis criteria of GAD in DSM-5 [ 1 ]. The set of symptoms includes two core symptoms: “Today, to what extent did you experience excessive anxiety and worry about a number of events or activities?” (excessive worry), and “Today, to what extent did you feel difficult to control the worry?” (uncontrollable worry). Besides, the set also includes six other symptoms: “Today, to what extent did you experience restlessness or a feeling of being keyed up or on edge?” (restlessness); “Today, to what extent did you feel easily fatigued?” (fatigue); “Today, to what extent were you having difficulty concentrating or mind going blank?” (difficulty concentrating); “Today, to what extent did you experience irritability?” (irritability); “Today, to what extent did you experience muscle tension?” (muscle tension); “To what extent did you experience sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) last night?” (sleep disturbance). Participants used a Likert scale to evaluate the severity of each GAD symptom, ranging from 1 (not at all) to 7 (very much) [ 43 ]. The questionnaire composed of these eight items was administrated in Chinese, with a formal back-translation procedure performed by two independent language experts. To prevent the potential confounding effects of careless responses, an attention check question was inserted in the questionnaire (i.e., “Today, please choose 1 for this item.”), and responses with an incorrect answer to this question were deemed invalid [ 56 ]. The average daily internal consistency reliability for the GAD symptoms composite was 0.87 (Cronbach’s alpha), ranging from 0.80 to 0.93.

Data analysis

With responses collected for 50 consecutive days, the current study can be considered well-powered, based on the results of a series of simulations [ 50 ]. As discussed in the introduction, the multilevel vector autoregressive model, implemented in the package “mlVAR” [ 48 ], was employed to reveal the complex and dynamic system of the eight GAD systems. However, a notable limitation of mlVAR is its inability to handle missing data. To ensure the robustness of the current findings, two pre-processing strategies were employed to address missing responses prior to the mlVAR analysis. First, given the small amount of missing data (for the 8 ESM variables over 50 days, 1140 of the 46,000 data points (2.48%) were missing) and the lack of indication that these missing data did not emerge randomly, we did not apply any data imputation techniques but instead utilized the list-wise deletion strategy [ 43 ]. The results obtained from this strategy were reported below. The second strategy we employed is to impute missing entries in our time series data using the moving average method, which is considered one of the best methods for imputing missing data in time series. The results obtained from this strategy were detailed in the supplementary material. We then carried out the Kwiatkowski-Phillips-Schmidt-Shin test on each of our study variable and found that every variable fulfilled the requirement of stationary assumption. Moreover, these data also fulfilled the assumption which required the same time lag in a consecutive assessment.

The multilevel VAR allows slopes and intercepts to change between participants for the purpose of explaining possible interindividual differences. In a temporal network, a directed edge with an arrow connecting two nodes indicates the lagged relationship between these two nodes from one time point to the next. The direction of arrows represents the direction of the lagged relationship. In this study, we constrained random effects of incoming edges to a single node (in the temporal networks) to be orthogonal, such that the models are estimable. In temporal networks, an “and” rule is used to select significant edges: an edge is retained if both regressions on which the edge is based are significant (α = 0.05). Moreover, we also estimated contemporaneous network with undirected edges to captured the contemporaneous associations between these GAD symptoms. Contemporaneous associations have been understood as dynamics that may occur more limited timescale (e.g., within a few hours) than those obtained in the temporal network (i.e., daily in the current research) [ 50 ]. In the present study, these contemporaneous effects depict relationships emerging on the same day while temporal network describes the dynamics of variables on a day-to-day basis.

For the temporal network, it is needed to calculate the Out-strength and In-strength of each node. The Out-strength of a node refers to the absolute sum of weights of edges pointing to other nodes in the network, indicating the ability of a symptom affecting other symptoms in the next time point. The In-strength of a node refers to the absolute sum of weights of edges pointing to this node in the network, representing the extent of a symptom affected by other symptoms in the previous time point [ 49 ]. For the contemporaneous network, strength centrality was estimated by adding up the absolute edge weights of all edges linked with a node. This calculation reflects the overall extent of the connectivity of a specific node within the network [ 57 , 58 ]. In accordance with the reporting standards in the field of network analysis, all centrality indices were presented using raw scores [ 59 ].

The results of inter-individual differences in temporal network [ 60 , 61 , 62 ] and codes used in the analysis process can be found in the Supplementary Materials.

The range, average scores and standard deviations of individual symptoms are depicted in Table 1 . Among all of these symptoms, fatigue and excessive worry have the highest severity while muscle tension and irritability have the lowest.

The temporal network is shown in Fig. 1 . There are several obvious features emerge when summarizing the temporal network. Firstly, 22 edges (excluding 8 autocorrelation edges) are not zero (39%) among 56 possible edges (excluding autocorrelation edges) and all of these edges are positive. Secondly, sleep disturbance has Granger causal (predictive) effects on all other seven symptoms and the lagged relationships from sleep disturbance to fatigue (weight = 0.33), difficulty concentrating (weight = 0.23), irritability (weight = 0.19) and uncontrollable worry (weight = 0.19) have the highest weights. Thirdly, all of these eight symptoms have autocorrelations (edges pointing toward themselves). This means that all these symptoms have Granger predictive effects on themselves. Sleep disturbance (weight = 0.15) and excessive worry (weight = 0.15) have the highest autocorrelations. Finally, there are some interesting feedback loops in the temporal network. For example, excessive worry has predictive effect on uncontrollable worry (weight = 0.10) which in turn has predictive effect on excessive worry (weight = 0.08). Fatigue predicted muscle tension (weight = 0.05) which in turn predicted fatigue (weight = 0.04). There are bidirectional feedback loops among restlessness, fatigue and difficulty concentrating, and also feedback loops between either two of them (specific weights see Fig. 1 ). The contemporaneous network is shown in Fig. S3 . Strong associations are found between uncontrollable worry and excessive worry (weight = 0.48), uncontrollable worry and restlessness (weight = 0.25), excessive worry and restlessness (weight = 0.25), fatigue and difficulty concentrating (weight = 0.24), and irritability and muscle tension (weight = 0.23).

Temporal networks of generalized anxiety disorder symptoms. Note Blue edges represent positive relationships between nodes, red edges represent negative relationships between nodes. Thicker edges between nodes represent stronger relationships. The numbers represent significant edge weights

The Out-strength and In-strength (excluding autocorrelation) of GAD symptoms in the temporal network are shown in Table 1 ; Fig. 2 . Sleep disturbance has the obviously highest Out-strength among these symptoms, indicating the predictive effect of this symptom on other symptoms in the next time point is strongest. In other words, the more sleep disturbance a participant has at one time point, the more likely the participant is to report other symptoms of GAD at the next time point. Irritability has the lowest Out-strength (value = 0) among these symptoms, indicating this symptom does not have predictive effect on any other symptoms. Meanwhile, fatigue has the highest In-strength among these symptoms, which means that this symptom could be predicted, to the largest effect, by other symptoms in the former time point. Sleep disturbance has the lowest In-strength (value = 0) among these symptoms, indicating this symptom could not be predicted by any other symptoms in the former time point. The strength centrality of GAD symptoms in the contemporaneous network is shown in Fig. S4 . Uncontrollable worry has the highest overall connectivity in the network, followed by restlessness and excessive worry.

Strength centrality of generalized anxiety disorder symptoms within the temporal networks

The temporal network estimating by dataset which used moving average imputation strategy is shown in Fig. S1 (in the Supplementary Materials). Fig. S3 (in the Supplementary Materials) shows the Out-strength and In-strength (excluding autocorrelation) of GAD symptoms. In fact, the results of temporal networks estimating by dataset which used moving average imputation strategy and list-wise deletion strategy (i.e., did not apply any data imputation techniques) are very similar. This further proves the robustness of the analysis.

To the best of our knowledge, this is the first article exploring the dynamics internal structure of GAD symptoms based on DSM-5 diagnostic criteria by using daily life data from participants with elevated GAD-7 scores. The temporal network could unfold how the symptoms of GAD interact with each other and strengthen themselves over time on an average scale. Meanwhile, the strength centrality could cast light on which symptoms may play an important role in the dynamic development and maintenance process of GAD.

In temporal network, a lot of lagged relationships exist among GAD symptoms and these lagged relationships are all positive. These results may support the network theory of mental disorders which pointed out that mental disorders arise from direct interactions between symptoms [ 4 ]. Sleep disturbance has predictive effects on all other GAD symptoms and the lagged relationships from sleep disturbance to fatigue and difficulty concentrating have the highest weights. The lagged relationships between sleep disturbance and these two symptoms are frequently observed in empirical settings and may be interpreted as: the more sleep disturbance the person has in the former night, the more fatigue and difficulty concentrating he might have in the next day [ 63 ]. Previous studies have shown that individuals with sleep disturbance, such as insomnia, exhibit evidence like increased hypothalamic-pituitary-adrenal activity [ 64 ], sympathetic tone [ 65 ] and daytime arousal [ 66 , 67 ]. These changes would lead to a higher likelihood of activating cognitive, emotional, and behavioral symptoms of GAD, such as irritability, restlessness, muscle tension, instability of thinking activities and emotions, and so on [ 68 , 69 ]. In fact, there are many studies using different research methods that indicate sleep disturbance can predict anxiety [ 70 , 71 , 72 , 73 ]. Based on our knowledge, the contemporary theories of GAD rarely mention the role of sleep disturbance in the development and maintenance of GAD [ 8 ]. An important contribution of the current research is the first investigation of the temporal network of GAD symptoms based on DSM-5, which identified a widespread predictive effects of sleep disturbance on other GAD symptoms. Such findings may facilitate further development of GAD theoretical models.

In accordance with previous temporal studies of psychopathological dynamics [ 42 , 43 , 57 ], all symptoms in temporal network had autocorrelations. This means that these symptoms can predict themselves from one time point to the next time point. This may be the first indication of a ‘critical slowing down’, because of the gradual crystallization of pathological responses [ 74 ].

Some vicious cycles also deserve special attention. Consistent with previous dynamic network analysis studies including excessive worry and uncontrollable worry [ 57 , 58 ], the current study finds that excessive worry has predictive effects on uncontrollable worry and uncontrollable worry also has predictive effects on excessive worry. In other words, excessive worry and uncontrollable worry can strengthen each other over time, which may lead to more severe clinical symptoms. This is understandable as that when individuals feel difficult to control the worry, they will worry about a number of events or activities, vice versa. In line with prior articles [ 57 , 58 ], a strong contemporaneous association between these two symptoms is also detected within the same day highlighting how excessive worry and uncontrollable worry may aggravate each other on a closer time scale. This finding supports the MCM of GAD (more details see Introduction section), which emphasizes the causal interactions between Type 1 worry (i.e., excessive worry) and Type 2 worry (e.g., uncontrollable worry) [ 9 , 75 , 76 ]. The same type of loops also appears between fatigue and muscle tension, and among restlessness, fatigue and difficulty concentrating. These loops may provide important ways for us to understand the development and maintenance of GAD. Further studies are needed to understand these loops.

Strength centrality results show that sleep disturbance has the obviously highest Out-strength and lowest In-strength among GAD symptoms. Thus, sleep disturbance of the previous day has a great ability to predict all the other symptoms on the next day. This result indicates that sleep disturbance may play an important role in the dynamic development and maintenance process of GAD. A recent study showed that having a full night of sleep is helpful in remitting anxiety and mood-stabilizing, while a lack of sleep causing anxiety levels to rise by as much as 30% [ 73 ]. Additionally, strength centrality results show that fatigue has the highest In-strength. Thus, fatigue is greatly affected by other symptoms in the previous time point. This might be one of the reasons for its high severity. Moreover, uncontrollable worry has the highest overall connectivity in the contemporaneous network, indicating its central role in GAD various symptoms on a within-day basis. Thus, this result provides some evidence that the MCM provides a good theoretical framework for conceptualizing GAD [ 9 , 75 ].

Due to sleep disturbance predicts all other GAD symptoms at the next time point and it has the obviously highest Out-strength among GAD symptoms, it is vital to reconsider the importance of sleep disturbance: the present study probed that sleep disturbance may not be merely an accompanying symptom of GAD but an important cause of GAD symptoms from a temporal network perspective. A recent review also pointed out that sleep disturbance is likely to be a contributory causal factor in the occurrence of most mental health conditions [ 77 ]. Thus, it may be reasonable for a clinical worker to take sleep disturbance as an important target for intervening, in contrast to the current mainstream treatment of psychiatric disorders which considers the treatment of sleep disturbance as an afterthought in patient care [ 77 ]. In other words, having a good sleep may be an excellent solution for GAD. Recent treatment efforts have also shed light on the benefit of treating sleep disturbance before other symptoms among patients with various psychiatric disorders [ 77 ]. As a multi-component and evidence-based treatment [ 78 ], cognitive behavioral therapy for insomnia (CBT-I) has been highlighted as the first choice for patients with insomnia disorder in recent treatment guidelines [ 79 , 80 , 81 ]. It is encouraging to note that an open trial study suggests that CBT-I is an effective therapy for patients with co-morbid insomnia disorder and GAD [ 82 ]. More clinical treatment studies can be conducted in the future. In addition, these results may imply the importance of sleep disorders in the diagnosis of GAD. It is worth mentioning that GAD-7, as a widely used tool for screening GAD and evaluating its severity [ 41 ], does not include sleep disturbance item, which may reduce its screening and evaluation performance. This still needs further exploration. Finally, considering the highest overall connectivity of uncontrollable worry in the contemporaneous network, the uncontrollability of worries should also be considered a priority target, similar to metacognitive therapy for GAD [ 83 , 84 , 85 ].

Some limitations are noteworthy in the present study. First of all, multilevel VAR models are complex with a large number of parameters to be estimated, therefore a relatively large sample size (including both the number of observations and the number of measurements per observation) is required for stable and consistent estimation [ 86 ]. According to previous methodological review and simulation studies [ 86 , 87 ], the number of observations (115) analyzed in the current study and the number of measurements per observation (50) are close to the medium level (i.e., 100 for the number of observations and 60 for the number of measurements) and can lead to robust estimations of the multilevel VAR model. We also encourage future research use different samples in other settings (e.g., observations coming from different countries or different cultures) to further examine the robustness of our findings. Second, instead of patients with a definite diagnosis of GAD, we recruited undergraduate students whose sum-score exceeded the clinical threshold of GAD screening tool (i.e., GAD-7) in this study. This may lead to a lack of representativeness of the clinical sample. Third, if the time window between assessments were different from the development of the actual relationship between symptoms, it might be hard to discover critical underlying relationships when purely based on the current set of analyses. For example, the predictive relationship between symptoms within a timescale of several hours might not be revealed from a network based on daily assessments. Fourth, there are many different manifestations of sleep disturbance (i.e., difficulty falling or staying asleep, or restless, unsatisfying sleep). So, it is not possible to find out how a specific manifestation of sleep disturbance affects other symptoms of GAD by using the item of general sleep disturbance. Restlessness (i.e., restlessness or a feeling of being keyed up or on edge) and difficulty concentrating (i.e., difficulty concentrating or mind going blank) also share this problem. For future studies, we encourage researchers to separate the many aspects of these symptoms and hence provide an even more detailed analysis of the interplay of symptoms. Last but not least, combining ESM with network models is a novel exploratory method, instead of a confirmatory method, which needs to be considered when interpreting current results [ 88 ].

The present study is the first study combining experience sampling methodology with network analysis in exploring the temporal network of GAD symptoms based on DSM-5, using daily life data derived from participants with elevated GAD-7 scores. This study establishes a preliminary exploratory empirical conceptualization of how GAD symptoms interact with each other and strengthen themselves over time, and particularly highlights the relationships between sleep disturbance and other GAD symptoms. Sleep disturbance may play an important role in the dynamic development and maintenance process of GAD. The present study may develop the knowledge of the diagnosis, prevention and intervention of GAD from temporal symptoms network perspective.

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request. The codes can be found in the Supplementary Materials.

Abbreviations

Generalized anxiety disorder

Metacognitive model

Generalized Anxiety Disorder 7-Item Questionnaire

Diagnostic and Statistical Manual of Mental Disorders, the fifth Edition

Experience sampling methodology

Vector autoregression models

cognitive behavioral therapy for insomnia

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association; 2013.

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Acknowledgements

We would like to thank all the individuals who participated in the study. We also thank all the administrative staff and teachers in the university who help us with the recruitment.

XL’s involvement in this research was funded by the Year 2022 Major Projects of Logistic Research Grant and the Key Project of Air Force Equipment Comprehensive Research (KJ2022A000415). SW’s involvement in this research was funded by the Key Project of the “14th Five-Year Plan” for Logistics Research (BKJ21J013) and National Natural Science Foundation of China (72374208).

Author information

Jiaxi Peng, Shuai Yuan and Zihan Wei contributed equally to this work.

Authors and Affiliations

Mental Health Education Center, Chengdu University, 610106, Chengdu, China

University of Amsterdam, 1018WB, Amsterdam, the Netherlands

Xijing Hospital, Air Force Medical University, 710032, Xi’an, China

Brain Park, School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, 3800, Clayton, VIC, Australia

Department of Psychology, Army Medical University, 400038, Chongqing, China

Kuiliang Li

Department of Psychology, Renmin University of China, 100000, Beijing, China

School of Psychology, Capital Normal University, 100089, Beijing, China

Shangqing Yuan

Department of Military Medical Psychology, Air Force Medical University, 710032, Xi’an, China

Zhihua Guo, Lin Wu, Tingwei Feng, Qun Yang, Xufeng Liu & Shengjun Wu

Military Psychology Section, Logistics University of PAP, 300309, Tianjin, China

Yu Zhou, Jiayi Li & Lei Ren

Military Mental Health Services & Research Center, 300309, Tianjin, China

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Contributions

JP, SY, ZW, XL, SW and LR conceived and designed the study and interpreted the study results. SY and LR analysed the data. JP, SY, ZW and LR wrote the paper. CL, KL, XW, SY, ZG, LW, TF, YZ, JL, QY and XL critically reviewed drafts of the paper. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Shengjun Wu or Lei Ren .

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This study was conducted in accordance with the ethical standards put forth in the Declaration of Helsinki. The questionnaire was completed online in the WeChat application after informed consent was obtained. The study design and procedures were reviewed and approved by the Independent Ethics Committee of the First Affiliated Hospital of the Fourth Military Medical University (No. KY20182047-F-1).

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Peng, J., Yuan, S., Wei, Z. et al. Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder. BMC Psychiatry 24 , 241 (2024). https://doi.org/10.1186/s12888-024-05698-z

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