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This chapter provides a typology of disorders of fear and anxiety — such as anxiety disorder, phobias including agoraphobia, panic, and social anxiety, post-traumatic stress disorder, and obsessive-compulsive disorder — mapping them to the two-dimensional framework provided by Chapters 2 and 6. It treats syndromes as resulting from unusual reactivity of structures and symptoms as resulting from unusual activity, with symptoms not providing a good guide to syndromes. Specific tests for some syndromes are derived from the theory.

This chapter reviews the literature on mechanisms that underlie the onset and evolution of adolescent anxiety disorders as they relate to the development of anxiety in youth. It begins by examining adolescents' increased risk for anxiety disorders and the roles that social and biological, particularly neural, changes may play in its onset. Particular attention is given to the Social Information Processing Network (SIPN) which has both early (emotional) and later maturing (cognitive control) components. It then considers alterations in patterns of cognition that are associated with adolescent anxiety disorders, as well as their putative underlying neural mechanisms. The chapter describes an approach to studying the intersections among adolescent psychopathology, emotion and cognition, and underlying neural substrates. Finally, possible prevention approaches that integrate neuroscience and clinical research are presented.

This chapter reviews contemporary neurocircuitry models of anxiety disorders, with a focus on the role of the orbitofrontal cortex (OFC). In addition to human neuroimaging studies, findings from animal research are also considered, with emphasis on fear conditioning and extinction paradigms. The anatomical distinction between medial and lateral OFC is highlighted; medial OFC has been implicated in rewards and conditioned fear extinction recall, whereas reciprocally the lateral OFC has been implicated in evaluating punishers and mediating negative affects. As similarities and differences across the anxiety disorders are explored, the distinction is made between: 1) exaggerated ‘bottom-up’ amygdala responses; 2) failure of ‘top-down’ control by the medial OFC; and 3) excessive lateral OFC activity in concert with striatum. In this way, the clinical phenomena associated with the various anxiety disorders are linked to sub-territories of OFC, and understood in terms of their anatomical connections and the normal functions these neural circuits subserve.

This chapter presents the evidence base for clinic and school-based interventions for four common childhood disorders or related symptom patterns: attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), disruptive behavior disorders, and anxiety disorders and related symptoms. It shows that within the existing base for each disorder, psychosocial interventions include an array of behavioral approaches. The psychopharmacology evidence base is strongest for ADHD, weaker for other disorders, and virtually nonexistent for anxiety disorders. Adjunctive studies examining a combination of psychosocial and psychopharmacological interventions were rare, with the largest and most sophisticated one for ADHD.

This chapter discusses behaviour therapy, drug therapy (antidepressants), cognitive-behavioural therapy for the treatment of disorders such as anxiety disorder and their possible interactions, in the context of the theory.

In a recent survey conducted by the authors, anxiety disorders stood out as one of the most significant mental health problems school social workers face in their practice. This chapter uses an evidence-informed process (EIP) to search for the best available evidence to help students with anxiety disorders in schools. It shows that school social workers, provided they have been trained in basic cognitive behavioral therapy (CBT) concepts, have a wealth of empirically supported resources to draw on in designing interventions for their students.

This chapter reviews treatments for anxiety disorders. These include psychoanalytic/psychodynamic therapies; behavioural, cognitive, and cognitive behavioural therapy; new wave cognitive behavioural therapies, multimodal therapies, other interventions for music performance anxiety, emotion-based therapies, performance-based approaches, pharmacotherapy for anxiety disorders, and treatment of anxiety disorders in children and adolescents.

Chapter 6 presents an overview of anxiety disorders and outlines the specific disorders. Recent research on epidemiology is provided. The psychological and biological aspects of anxiety and response to interpersonal trauma are described. PTSD and Complex PTSD, the anxiety disorders that occur in the aftermath of trauma, is explained. The chapter includes a discussion of assessment and diagnostic considerations for anxiety disorders and PTSD. Evidence-supported psychosocial and pharmacological treatment approaches for both are reviewed, and key principles for treatment are provided.

This chapter examines the construct of anxiety in greater detail and reviews the various diagnoses within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) of the American Psychiatric Association, which included anxiety as a central feature of the disorder. These include generalized anxiety disorder, social phobia/social anxiety disorder, specific phobia, panic disorder, and obsessive-compulsive disorder. It briefly examines the issues related to categorical versus dimensional conceptualizations of mental disorders, and how these disorders are classified, their defining features and their commonalities and differences. It shows that comorbidity, the co-occurrence of two or more disorders, is very common, and that high rates of comorbidity point to the possible artificiality of categorical classifications of psychological disorders. Depression and its various manifestations (e.g., dysthymia and major depression) are common comorbid conditions with the anxiety disorders. The anxiety disorders in the DSM in the context of the characteristics of music performance anxiety are reviewed.

This chapter attempts to define music performance anxiety, recognizing that the accurate naming of a phenomenon is a first and essential step in its analysis and eventual understanding. To date, performance anxiety has not been classified within the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and that even among music researchers, there is no consensus regarding the definition of music performance anxiety. The term ‘stage fright’ has been used interchangeably, somewhat unsatisfactorily, with the term ‘music performance anxiety’. In attempting to capture the essence of the condition, current conceptualizations of music performance anxiety are reviewed as a dimensional construct, as occupational stress, as a focal anxiety disorder, as social anxiety or social anxiety disorder (social phobia), and as a panic disorder. The comorbidity of music performance anxiety with other disorders is also considered, in particular social anxiety disorder. In the final section, a number of frequently observed characteristics of people who suffer performance anxiety are reviewed, including trait anxiety, neuroticism, negative affectivity, introversion, and behavioural inhibition; fear of negative evaluation; low self-concept, self-esteem, self-efficacy, and locus of control; perfectionism; and narcissism and shame.

The changing demographics of American society have received a great deal of attention in recent years. As the population ages, the overall number of elderly persons with mental disorders, particularly anxiety and mood disorders, will increase. Older adults with mental health problems are likely to have relatively longer life spans in the future due to expected advances in treatments and healthier aging lifestyles. Mental health problems will demand more attention from providers in order to minimize their effects on disability, the use of health care services, and the quality of life for older adults and caregivers. This chapter presents the current state of knowledge on mental disorders of late life (mental disorders, anxiety disorders, psychotic disorders), focusing on prevalence, consequences, and effective evidence-based treatments.

This chapter examines issues concerning anxiety and adjustment disorders experienced by patients in palliative care. Several studies have found that patients with advanced cancer often have co-morbid psychiatric problems including a high frequency of adjustment disorders and anxiety. While the identification of these disorders can be done by oncology staff, it is advisable for palliative care practitioners to work with other professionals, such as psychiatrists and psychologists, to provide appropriate mental health care and enhance the quality of life of the patient and family.

The main characteristics of generalized anxiety disorder (GAD) are chronic pathological worry, other manifestations of nonphobic anxiety, and various symptoms of tension. Physical symptoms of anxiety are usually less prominent in GAD than in panic disorder, but they can still be an important component of clinical presentation. Behaviors that are often seen in other anxiety disorders, such as overt avoidance, are conspicuously absent. Unlike all other anxiety disorders, it is more likely for GAD in clinical setting to co-occur with a primary condition for which help has been sought–usually depression or other anxiety disorder–than to be the main reason for seeking professional help. Generalized anxiety disorder is one of the more controversial members of the family of anxiety disorders: it seems that almost every aspect of GAD has provoked debates that do not show signs of abating. Paradox, disagreement, debate, and controversy are the words most commonly associated with GAD. It is small wonder then that the list of ‘‘hot topics’’ related to GAD could be very long indeed. Listed below is a selection of issues thought to represent adequately a more comprehensive list…. 1. What are the characteristic features of GAD that would help in its conceptualization? Pathological worry, other cognitive aspects of anxiety, manifestations of tension, and/or (some) symptoms of autonomic arousal? What combination of these features would ensure that GAD is diagnosed adequately and recognized in clinical practice? 2. What is the relationship between pathological worry and GAD? 3. How can different views on what constitutes the essence of GAD be reconciled? Is GAD a single entity or are there two or more ‘‘types’’ of GAD with distinct clinical characteristics? 4. How is GAD related to depressive disorders, other anxiety disorders, and personality disturbance? Where are its boundaries? In view of its close relationship with depression, should GAD be classified along with depression and perhaps renamed accordingly? 5. Can GAD exist on its own, without depression or other anxiety disorders? What could be features specific enough for GAD that would allow it to establish itself as an independent and valid psychopathological and diagnostic entity? 6. What are the pathophysiological correlates of pathological worry and other aspects of chronic anxiety in GAD? 7. What are the underlying mechanisms and purpose of pathological worry in GAD? What is the meaning of chronic anxiety?

This chapter discusses sex differences in anxiety disorders. Topics covered include clinical features of anxiety disorders, determinants of sex differences, hormonal influence on anxiety disorders, and the presence of antithyroid antibodies and anxiety.

This chapter examines how memory might be influenced by a variety of emotional states and conditions experienced by people with anxiety disorders. It reviews research performed with people who describe themselves as generally anxious (without formal diagnosis), as well as with people who have been diagnosed as experiencing generalized anxiety disorder, post-traumatic stress disorder, phobias, obsessive-compulsive disorder, and panic disorder. In the context of research on “mood congruent” memory, one might expect that these individuals will better remember stimuli that “fit” with their anxious thoughts and beliefs. In some cases, anxious people do show evidence of anxiety-related memory bias, but these probably result from special instances of emotional interpretation of events with ambiguous meaning. Under conditions less prone to interpretive ambiguity, anxious people tend not to remember in emotionally special ways.

The first part of this chapter addresses the following questions: How common is music performance anxiety? Does it occur with equal frequencies among male and female performers; adult, adolescent, and child musicians; classical and popular musicians; orchestral and choral musicians; professional and amateur musicians? The second part reviews methods of assessment of music performance anxiety. Analysis of the existing assessments highlighted the complexity of this undertaking, particularly in view of the fact that different forms of assessment measurements — physiological, subjective feelings of discomfort (the emotion or affect of anxiety), cognitive (worry, dread, and rumination), and overt behavioural (shaking, trembling, posture, muscle tension) — are not interchangeable. Many of the available music performance anxiety scales are adaptations of existing anxiety measures, assess symptoms only and have no theoretical basis. New measures — the Kenny Music Performance Anxiety Inventory for adult musicians and the Music Performance Anxiety Inventory for Adolescents for adolescent musicians — have attempted to address shortcomings in existing measures by attending to relevant psychometric properties of robust tests and providing a theoretical rationale for the items.

Anxiety disorders are considered the most common and earliest occurring mental disorders. They are associated with social, academic, and occupational impairment in childhood, and increased risk of a range of mental health problems throughout development and into adulthood. This chapter examines the prevalence, correlates, risk factors, continuity/outcomes, and treatment of specific phobia, generalized anxiety disorder, panic disorder, separation anxiety disorder, social phobia, and obsessive–compulsive disorder over the life course. Also discussed are the implications of a life course approach on the epidemiology of anxiety disorders for clinical work, public health, and future research.

Anxiety disorders have the highest prevalence of any group of mental disorders. This chapter primarily focuses on three of these anxiety disorders: generalized anxiety disorder, social anxiety disorder, and separation anxiety disorder. These three anxiety disorders have shared characteristics, are often comorbid, can continue into adulthood, and are predictors of other adulthood anxiety disorders. In schools, where many children and adolescents spend large quantities of time, anxiety can hinder academic performance, inhibit social relationships, and impact other important areas of functioning. Anxiety disorders in children or adolescents should be assessed using tools with empirical support and should include information triangulated from several sources. Treatment should cater to the level of need, such as cognitive-behavior therapy with individuals or groups. Collaborating with teachers, parents, and other community members is important for addressing anxiety thoroughly. A case example portrays these aspects of anxiety disorders in school-age youth.

This chapter raises the possibility that music performance anxiety at its most extreme might constitute a disorder of the self. It applies to a subgroup of musicians whose experience of anxiety is so pervasive and profound that it is experienced as a defining characteristic of their sense of self. Attachment theory is discussed at length before two narratives produced from transcripts of interviews are presented and reviewed from an attachment-based psychotherapy perspective, which posits that one's relational experiences in early life, and the subsequent quality of one's attachment experiences, may affect and, indeed, direct behaviour, beliefs, emotions, and relationships throughout life. It is argued that attachment theory offers the most heuristic and evidence-based insights into this subgroup of musicians and that the psychodynamic psychotherapies may offer the best hope of treatment.