main problem in Anxiety Disorders is not in the generation of anxiety, but in
the overactive cognitive patterns or frames of reference relevant to danger that
are continually creating external and/or internal experiences as a sign of danger.
According to Beck, the symptoms that indicate an
anxiety disorder can be divided into cognitive, affective, behavioral, and physiological.
These are based upon the four functional systems that are coordinated to produce
adaptive responses to situations of danger. Anxiety disorders represent a malfunction
of the system for activating and terminating a defensive response to a threat,
thus causing prolonged anxiety. This is a response that can be understood as inappropriate
domination by a primal mechanism, such as flight, freeze, or collapse... rather
than a more adaptive way of behaving, like social competency. The activation of
the primal response to a threat such as possible rejection by an audience in public
speaking undermines your client's more mature functioning. Thus, the threat is
increased. Your client's symptoms are expressions of the excessive functioning
of his or her systems, or of an interference with the function of a particular
Below is a list of many of the "cognitive symptoms"
associated with Anxiety Disorders. It will be apparent that many of these symptoms
are intensified versions of normal function; for example, self-consciousness or
hypervigilance. Other symptoms appear to be the result of inhibition of normal
functions -- for example, loss of concentration or blocking. Still other symptoms
denote erosion of voluntary control over processes ordinarily under your client's
control, such as loss of objectivity. Please note the list is in a checklist format
for your convenience, and reproduction to use for further client assessment.
2. Thinking Difficulties
Can't recall important things
Confused, Unable to control thinking
Difficulty in concentration
Difficulty in reasoning
Loss of objectivity and perspective
Cognitive distortion, Repetitive fearful
Fear of losing control
Fear of not being able to cope
Fear of physical injury/death
Fear of mental disorder, negative evaluations
Frightening visual images
sensory-perceptual symptoms appear to be caused by an interference with normal
cognitive function. This interference is possibly a result of cognitive strain.
Thus, the integration of visual impressions with the cognitive schemas is unbalanced.
The individual experiences perceptual aberrations. These aberrations are readily
recognized as such and have an "as if" quality. Your client may state,
"Things seem to be different, but I know they aren't." Many agoraphobic
clients report, for instance, that after they have been looking at the broad fluorescent
light in the supermarket, objects seem to be split horizontally and the separate
parts are dissociated.
These conceptual problems are related to
changes in the cognitive processes by the primal mode. These changes reflect preoccupation
with the sense of vulnerability and danger. The focus on fears, loss of control,
and inability to cope are an expression of the cognitive frame of reference. This
frame of reference is one of "danger" and "vulnerability."
As you know, the types of symptoms of anxiety will vary according to the
nature of the problem. If it is immediate and severe, the person may experience
panic. If the problem is chronic, he or she is more likely to experience uneasiness
or a "wound-up" feeling. Use the following checklist to assess and provide
insights into interventions with past or future clients.
behavioral symptoms, as we will discuss later, generally reflect either the
hyperactivity of the behavioral system or else its inhibition. Tonic immobility
is an expression of the freeze reaction, whereas restless behavior and tremors
represent the body's mobilization for action. The shaking and trembling may represent
the preparation for survival behavior prior to the formulation of a clear-cut
physiological symptoms reflect a readiness of the total organism for self-protection.
The sympathetic branch of the autonomic nervous system facilitates an active coping
strategy. Thus, increased heart rate and blood pressure help a person defend himself
actively or to escape. The parasympathetic symptoms, in contrast, facilitate the
strategy of collapse. They ultimately may result in your client feeling he or
she is helpless and has no active coping strategies for dealing with a threat.
Some physiological symptoms result from behavioral reactions; for example, numbness
and tingling sensation in the extremities and faintness may be caused by over-breathing
or hyperventilation syndrome.
According to Physiological Symptoms
Increased blood pressure
Localized sweating (palm region)
and cold spells"
Note: (P) Represents parasympathetic symptoms that facilitate
the strategy of collapse
Reactions: Mobilization, Inhibition, Demobilization
response to a threat can be discussed in terms of three major types of reaction.
Mobilization prepares him or her for active defense. Inhibition can be expressed
by the freezing reaction. Inhibition is designed to curtail "risky behavior"
and to buy time to determine an appropriate strategy. Demobilization denotes deactivation
of the motor apparatus and reflects a sense of helplessness in the face of an
Mobilization may be represented physiologically
by activation of the systems for purposes of action. This pattern may be observed
as follows in the various systems. a. Cognitive. The individual is
hypervigilant for any cues relevant to danger. The threshold for unexpected or
loud stimuli is lowered. The content of ideation deals with dangerous events past,
present, and future and may take the form of repetitive automatic thoughts. Your
client has frequent visual images with a content of personal adversity. Your client
is also likely to have nightmares. b. Affective. The emotional symptoms
may vary from edginess and tension to terror. c. Behavioral. There
is an increase in muscular activity even when sitting. This may be manifested
by grimacing, by continuous movements of hands and often the rest of the body,
and by chain smoking, sighing, shaking, tremors, and pacing back and forth. d. Physiological. The organ systems show increased sympathetic activity;
for example, increased heart rate and blood pressure, and sweating.
Inhibition involves active interference with normal cognitive and behavioral functions. a. Cognitive. There is selective blocking of various functions, especially
when an activity is being evaluated or challenged. There may be interference with
recall of vital information, for example, the content of a speech, a response
to a test, people's names, or phone numbers. Reasoning, concentration, objectivity,
and perspective are impeded. The blocking and impediments may be varied over time
as though a switch is being turned on and off. The "clouding of consciousness,"
"mental blurring," and sense of "passing out" may also be
attributed to cognitive inhibition. This constriction of consciousness may intensify
to the point that your client believes that he or she is about to faint. b.
Behavioral. There is inhibition of spontaneous movements, especially of facial
muscles, so that the person may present a blank face. Some rigidity of facial
muscles is apparent. There is also general muscle rigidity, so that movements
are jerky and clumsy and activity requiring skill, such as playing a musical instrument,
is impeded. There is often a problem with phonation and with dysfluencies such
as stuttering, choking on words, or even partial mutism.
Demobilization. The symptoms of collapse occur most obviously in an overreaction to blood and
injury but may appear in other reactions as well. The main symptoms are weakness
and faintness. The main parasympathetic symptoms that are most prominent in the
blood injury phobias are a lowering of the blood pressure and heart rate that
may result in fainting.
Reflection Exercise Explanation The
Goal of this Home Study Course is to create a learning experience that enhances
your clinical skills. We encourage you to discuss the Personal Reflection
Journaling Activities, found at the end of each Section, with your colleagues.
Thus, you are provided with an opportunity for a Group Discussion experience.
Case Study examples might include: family background, socio-economic status, education,
occupation, social/emotional issues, legal/financial issues, death/dying/health,
home management, parenting, etc. as you deem appropriate. A Case Study is to be
approximately 350 words in length. However, since the content of these Personal
Reflection Journaling Exercises is intended for your future reference, they
may contain confidential information and are to be applied as a work in
progress. You will not
be required to provide us with these Journaling Activities.
Reflection Exercise #1 The preceding section contains Checklists to fine
tune your assessment of clients who may have Anxiety Disorders. Write three case
study examples regarding how you might use the content of this section of the
Manual in your practice.
Online Continuing Education QUESTION
18: What are three types of reactions your client may have
to a threat? To select and enter your answer go to CE Test.