Anxiety Project Intro (2).docx

.Anxiety definition Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure(American psychological association ,1994 ) Anxiety is best defined as an intense feeling of unease, worry, and fear. It is common to feel anxiety when faced with a challenging situation ( Yolanda Williams ) Anxiety is the anticipation of impending danger and dread accompanied by restlessness, tension, rapid heartbeat, and rapid breathing that may or may not be associated with a certain event or situation (Mosby's Dictionary of Medicine, Nursing, and Health Professions) A feeling of impending danger that can be based on objective, neurotic or threats (Sigmund Freud ) An emotional state of a human during life is both life – saving and also causes many problems in the mental life of human beings. The feeling of worry, nervousness, or unease about something with an uncertain outcome. When an individual faces potentially harmful or worrying triggers, feelings of anxiety are not only normal but necessary for survival. (Garner, et.al., 2009) Anxiety serves as the body’s warning system – the brain’s way of telling the body that something bad could happen. This response relates to but is distinct from fear, which alarms us when something actually dangerous is happening or is just about to happen. (Donald , et.al., 2013) State and trait anxiety The concepts of state and trait anxiety were first introduced by Cattell (1966; Cattell &Scheier, 1961, 1963) and have been elaborated by Spielberger (1966, 1972, 1976, 1979). In general, personality states may be regarded as temporal cross sections in the stream-of-life of a person (Thorne, 1966), and emotional reactions as expressions of personality states (Spielberger, 1972). Although personality states are often transitory, they can recur when evoked by appropriate stimuli; and they may endure over time when the evoking conditions persist. In contrast to the transitory nature of emotional states, personality traits can be

conceptualized as relatively enduring differences among people in specifiable tendencies to perceive the world in a certain way and in dispositions to react or behave in a specified manner with predictable regularity.Personality traits have the characteristics of a class constructs that Atkinson (1964) calls “motives” and that Campbell (1963) refers to as “acquired behavioral positions.”

History The twentieth century has been called the Age of Anxiety, but concerns about fear and anxiety are as old as humanity itself. Although fear has been of interest since ancient times, anxiety was not fully recognized as a distinct and pervasive human condition until shortly before the beginning of the present century. It was Freud who first proposed a critical role for anxiety in personality theory and in the etiology of psychoneurotic and psychosomatic disorders. Anxiety was the “fundamental phenomenon and the central problem of neurosis” (Freud, 1836, p.85).

Origin Angst

Anxiety The term ‘ anxiety ‘ is derived from the Greek word , ‘ angst ‘ which means fear. ( Watson et.al., 1988)

Levels of anxiety 1. Mild level of anxiety is healthy, at this level, perceptual field is heighten, pupils dilate to accommodate much light, hearing and smelling intensified, and sense of touch is highly

sensitive. The individual is highly alert and attentive and learning and cognition is in its best state. This stage improves academic performance. (Cohen , 2008 ) 2. Moderate level of anxiety on the other hand is unhealthy, the perceptional field of a person at this level is narrowed; individuals experiencing this level of anxiety have selective inattention. They have decreased focus and automatism can be observed as repetitive purposeless movements such as shaking of the hands and feet, twirling of hair and, tapping of fingers. Academic performance at this level depends on the individual's ability to control the anxiety and carry out the assigned task. (Gadye,2018) 3. Severe level of anxiety is characterized by reduced perceptual field and a difficulty in communication. Gross motor movements, such as pacing are characteristic of people at this stage. Academic performance at this stage depends on the educator's ability to recognize such individuals and provide a safe environment for them. Communication should be kept short and simple since communication is altered. Performance at this stage is reduced since most educators may not be able to provide such environment for the student.(Cohen , 2008 ) 4. Panic level of anxiety is the worst and most severe form of anxiety. Total disruption of perceptual field is present. It is also characterized by loss of ability to communicate, loss of rational thought and total loss of conscious thinking. Academic performance at this level is very poor since the student will be unable to remember exactly what he/she is supposed to do. (Khemiani et.al.,2012) Types of anxiety  Major category State anxiety State anxiety reflects the psychological and physiological transient reactions directly related to adverse situations in a specific moment. (Attwell, 2010) Trait anxiety Trait anxiety refers to the stable tendency to attend to, experience, and report negative emotions such as fears, worries, and anxiety across many situations.( Attwell, 2010)

Conscious anxiety Conscious anxiety is that which we know we fear. Snakes, heights, germs, a first date, a big presentation, taking a test, or going to the doctor are all common conscious fears. (Attwell, 2010) Unconscious anxiety Unconscious anxiety is that which is beyond our conscious awareness. This anxiety most often declares itself when someone has a panic attack seemingly out of blue. ( Attwell, 2010)  Other anxieties Generalized Anxiety Disorder People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. Generalized anxiety disorder symptoms include: 

Feeling restless, wound-up, or on-edge

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Being easily fatigued

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Having difficulty concentrating; mind going blank

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Being irritable

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Having muscle tension

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Difficulty controlling feelings of worry

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Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep. ( Stahl, S.M, 1996) Panic Disorder People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.

During a panic attack, people may experience: 

Heart palpitations, a pounding heartbeat, or an accelerated heartrate

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Sweating

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Trembling or shaking

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Sensations of shortness of breath, smothering, or choking

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Feelings of impending doom

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Feelings of being out of control People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia. ( Schmidt et.al., 2002) Phobia-related disorders A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia: 

May have an irrational or excessive worry about encountering the feared object or situation

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Take active steps to avoid the feared object or situation

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Experience immediate intense anxiety upon encountering the feared object or situation

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Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders: Specific Phobias (sometimes called simple phobias) As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of: 

Flying

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Heights

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Specific animals, such as spiders, dogs, or snakes

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Receiving injections

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Blood(Clarke ,2011 ). Social anxiety disorder (previously called social phobia) People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.(Claeke , 2011 ). Agoraphobia People with agoraphobia have an intense fear of two or more of the following situations:

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Using public transportation

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Being in open spaces

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Being in enclosed spaces

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Standing in line or being in a crowd

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Being outside of the home alone People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other

embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound. ( Bourne,E.J.,2005) Separation anxiety disorder Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated. ( Barlow,D.H.,2002) Selective mutism A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders. ( Attwell , 2010) Obsessive – compulsive disorder Obsessive Compulsive Disorder (OCD) involves unwanted and disturbing thoughts, images, or urges (obsessions) that intrude into a child/teen’s mind and cause a great deal of anxiety or discomfort, which the child/teen then tries to reduce by engaging in repetitive behaviors or mental acts (compulsions). Some examples for OCD habits are: 

Putting the money in denominational order, facing same way in my wallet when receiving change at the store.

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Buying things in multiples of two even the person is not in need of many number of things.

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Checking the lock, kitchen, pipes etc.. are shut or not when going out of house.

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Tapping the pencil before every new sentence is starting

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Counting everything that falls under the vision like tress, staircase etc… ( Schuster, 2017)

Post traumatic stress disorder Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after experiencing or witnessing a traumatic event, or learning that a traumatic event has happened to a loved one. DSM5 defines a traumatic event as exposure to actual or threatened death, serious injury, or sexual violence. (Herman, J.,1997) Health Anxiety Although health anxiety is not a disorder, there are several disorders defined by excessive anxiety related to somatic or physical symptoms, or having an illness or condition. In adults, these health worries are excessive, ongoing, and uncontrollable, and often result in frequent visits to medical professionals and reassurance seeking from loved ones all due to exaggerated fears of being ill. ( Albom, M., 1997) Hoarding Disorder (HD) Individuals with this disorder experience ongoing and significant difficulty getting rid of possessions regardless of their value; and strong urges to save and/or acquire, often nonessential, items, that if prevented leads to extreme distress. As a result, living space becomes severely compromised with extreme clutter. In addition, the individual experiences significant impairment in social, occupational, and other important areas of functioning. ( Bronson,P.,2002) Performance anxiety Any situation where you want to perform at your best and are worried about your ability to do so can create performance anxiety. It turns out that a person’s mentality is just as important

as their ability. The extreme nervousness experienced before or during participation in an activity. ( Yali et.al., 1999) Pregnancy anxiety A negative emotional state that is tied to worries about “the health and well-being of one’s baby, the impending childbirth, of hospital and health-care experiences (including one’s own health and survival in pregnancy), birth and postpartum, and parenting or maternal role” (Dunkel Schetter, 2011, pp. 534–535). Sexual anxiety Sexual anxiety is a fear of intense sexual gratification or sexual success. Avoidance of sexual activity is one of the most common manifestations of sexual anxiety. This anxiety can take the form of fear of contracting a sexually transmitted disease, unwanted pregnancy or feelings of newly discovered defectiveness in the partner. (Freud,A., 1946) Research and statistical data Researchers found that anxious individuals find it harder to avoid distractions and take more time to turn their attention from one task to the next than their less anxious peers. This makes learning, reading, remembering and writing difficult affecting academic performance. Since, the anxious individuals perform at a comparable level to the non-anxious ones with a greater cost in terms of effort or perhaps long term stress; it is believed that students with high anxiety as well as those with low anxiety will have lower academic performance. Therefore, those with moderate levels of anxiety will perform the best , maintained that if an individual's experience is negative, then anxiety level will be higher, leading to lower academic performance. Consequently, if an individual's experience is positive, then the anxiety level will be lower leading to higher academic performance. From these investigations, it has been observed that high and lower levels of anxiety is related to poor academic performance while a moderate level of anxiety is related to optimum academic performance. 

In addition, according to the World Health Organization (WHO), 1 in 13 globally suffers from anxiety. The WHO reports that anxiety disorders are the most common mental disorders

worldwide with specific phobia, major depressive disorder and social phobia being the most common anxiety disorders. 

Approximately 4% of youth aged 13-18 will develop PTSD in adolescence

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Approximately 8% of children and teenagers experience an anxiety disorder with most people developing symptoms before age 21.

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OCD occurs in 2-3% of children and adults during their lifetime.

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Over the past fifty years, clinical studies of human anxiety have appeared in the psychiatric and psychoanalytic literature with increasing regularity, but prior to 1950, there was relatively little research on human anxiety (Spielberger, 1966).

Anxiety and studies Feeling anxious is sometimes perfectly normal however; people with severe form of anxiety find it had to control their worries. Their feeling of anxiety is more constant and often affects their performance or daily life. Many sources of anxiety have been reported for some time by students of Nursing Science Department which are often times related to long hours of study, practical work and assignments among others. If a student experiences an increased level of anxiety, the anxiety may have a negative effect, resulting in decreased learning. These extreme levels of academic related anxiety may cause some of them to even leave the programme. If nurse educators can better understand the anxiety levels of students of nursing department, they will be able to develop curricular and educational interventions to minimize the anxiety levels of students. Hence, the need to investigate the impact of anxiety on academic performance of students of the Faculty of Nursing, Niger Delta University, Bayelsa State, Nigeria. (Grillon, 1998). Theories of anxiety  Behavioural learning theory 

Classical conditioning According to behavioral psychologists, "learning" is indicated by a relatively permanent

change in behavior or knowledge. Learning can occur without any intention to learn, and without a conscious awareness that something has been learned. Any change in behavior suggests the person has learned a new response to a particular situation. Classical conditioning demonstrated

that people can be trained to produce these same reflexive, responses to a neutral stimulus, called a "conditioned stimulus" or CS. The CS is a stimulus that would not ordinarily cause the reflexive response. This learning occurs through a process called paired association. A reflexive behavioral response can be elicited by pairing an unconditioned stimulus (UCS) with a conditioned stimulus (CS). Thus, when a UCS and a CS repeatedly occur together, they form a paired association. (Argot, McEvily, & Reagans, 2003 ). 

Operant conditioning B.F. Skinner, one of the prominent psychologist of the last century conducted many

researches demonstrating that behavior was influenced not only by what occurred before it (as in classical conditioning, but also by what occurred afterward. Skinner believed that human beings (and animals) learn a behavior through a system of rewards and punishments. These rewards and punishment occur naturally in the external environment. When psychologists use the word "environment," they are referring to all the external events that are going on around a person. In behavioral terms, a reinforcement (reward) refers to anything that causes a behavior to increase. In contrast, a punishment is something that causes a behavior to decrease. If the environment rewards a behavior, that behavior is reinforced. This increases the likelihood that a person will repeat the same behavior in the future. Conversely, if the environment punishes a particular behavior, this decreases the likelihood the behavior will be repeated. His work resulted from teaching effective parenting skills to improving employee productivity and satisfaction in the workplace. (Argot, McEvily, & Reagans, 2003 ). 

Operant conditioning and avoidance learning Two

coping

strategies

for

dealing

with

anxiety

symptoms

are

called avoidance and escape. avoidance refers to behaviors that attempt to prevent exposure to a fear-provoking stimulus. Escape means to quickly exit a fear-provoking situation. In 1947, O. Hobart Mowrer proposed his two-factor theory of avoidance learning to explain the development and maintenance of phobias. Mowrer's two-factor theory combined the learning principles of classical and operant conditioning. Based upon the principles of classical conditioning, it was assumed that phobias develop as a result of a paired association between a neutral stimulus and

feared stimulus. However, classical learning theory could not explain the continuation of avoidance and escape behaviors. These behaviors often led to further distress and interference in a person's life such as: 1) the avoidance of pleasurable activities; 2) the inability to engage in daily activities and responsibilities; and 3) the inability to maintain interpersonal relationships. The second stage of Mowrer's model attempted to explain why people felt so compelled to avoid anxiety-provoking stimuli; or failing that, escape from the stimuli. The answer comes from Skinner's theory of operant conditioning and the environmental rewards produced by these coping strategies. Mowers proposed that the avoidance of (or escape from) anxiety-provoking stimuli resulted in the removal of unpleasant emotions. Thus, avoidance becomes a reward and reinforces (increases) the behavior of avoidance. (Argot, McEvily, & Reagans, 2003 ).  Cognitive theory In the 1950's, a psychologist named Albert Ellis, and a psychiatrist named Aaron Beck, which became popular cognitive theory. According to cognitive theory, our dysfunctional thoughts lead to extreme emotions. These extreme emotions in turn, lead to maladaptive behaviors. Albert Ellis's cognitive therapy is called Rational Emotive Behavior Therapy (REBT). He believed peoples' intense suffering from negative emotions was caused by their irrational core beliefs. Core beliefs refer to the basic beliefs people have about themselves and the world around them. He realized that people's internal thoughts and perceptions had a large influence on their emotions. He also believed that a more active and directive approach to modify thoughts would positively influence behavioral change. According to Beck, the way we interpret environmental events is a function of our core schema. A core schema is a central assumption about oneself, others, and the world. These assumptions influence our feelings and behavior.  Psychodynamic theory In 1890’s Freud didn’t consider anxiety to be related to thoughts or ideas, but he did observe that it was closely linked to sexuality, defining it as sexual excitation that has been transformed. Freud’s argument was that when the path to satisfaction is blocked, resulting buildup of unsatisfied libido takes on a toxic character, finding an outlet in anxiety. His theory of repression describes how the ideas connected to sexual urges are repelled from consciousness when they come into conflict with ‘civilized’ social norms. His earlier ‘toxic theory’ of anxiety

as transformed sexual excitation was preserved, but with an important modification: while his earlier views assumed the cause of anxiety to be external blocks to sexual release, the theory of repression shifted the emphasis to internal ones or psychological inhibitions. This new perspective led Freud to a complete reversal of his former position: whereas before he had posited anxiety as a result of repression, he now understood it as preceding repression and giving rise to it. (Butler & Mathews , 1983 ).

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Maslow’s hierarchy theory For Maslow, the goal of any human being is to reach a state of "self-actualization" in

which all their needs are met and a state of contented happiness is achieved. However, these needs must be met in a particular order. According to Maslow, higher forms of happiness are not achievable so long as these needs are not met. 

Roll May’s existential psychology May felt that the absence of an innate moral structure in the universe usually led to

people experience anxiety and distress because their expectations of the universe were simply not being met. His school of existential psychology is intended to deal with exactly this, the problems that arise from human consciousness working against the problems inherent in existence.(Butler & Mathews , 1983 ). 

Carl Roger’s – unconditional positive regard Carl Rogers was the first to advocate for the importance of "unconditional positive

regard", a way of viewing one's self in which one is unconditionally positive and accepting, maintaining the right to be critical without being judgmental or overly harsh. (Butler & Mathews , 1983 ) 

Social learning theory Social learning theory combines cognitive learning theory, which posits that learning is

influenced by psychological factors, and behavioral learning theory, which assumes that learning is based on responses to environmental stimuli. Psychologist Albert Bandura integrated these

two theories in an approach called social learning theory, and identified four requirements for learning—observation

(environmental),

retention

(cognitive),

reproduction

(cognitive),

and motivation (both). Bandura did the famous bobodoll experiment and concluded that children learn aggression, violence, and other social behaviors through observation learning, or watching the behaviors of others. (Bailey, 2007) 

Animal model of anxiety Many animal models of anxiety examine the natural behavioural patterns of mice and rats

to develop ethologically based behavioural tasks (Rodgers et al., 1997). These include ‘approach–avoidance' tasks (Cryan and Holmes, 2005) in which animals are exposed to an aversive/threatening environment e.g. open, elevated arms of the elevated plus-maze, light arena (light/dark exploration/emergence tests); and open field tests, with anxiety-like behaviour (phenotype) in each case, inferred from increased avoidance. Other models include social interaction tests (review by File and Seth, 2003), punishment-based conflict procedures (e.g. punished drinking — Vogel et al., 1971), defensive burying tests (Jacobson et al., 2007), predator stress (Blanchard and Blanchard, 1971), and the examination of ultrasonic vocalizations induced by stress such as maternal separation (see Sanchez, 2003), while novel techniques include the use of radiotelemetry to asses a variety of physiological parameters in real time (e.g. core body temperature, Adriaan Bouwknecht et al., 2007). Such models examine behaviour that is functionally rather than superficially related to human anxiety (i.e. they show good face validity) and probe mechanisms derived from theory (possess good construct validity). Anxiety is an aversive emotional state, in which the feeling of fear is disproportionate to the nature of the threat. In response to threatening situations, the feeling of the emotion that constitutes the subjective feature of anxiety is accompanied by emotional stress, which involves behavioral, expressive and physiological features, such as an avoidance of the source of the danger, assuming defensive postures and an increase in blood pressure, respectively. Anxiety is a normal emotional response to a threat or potential threat. When this emotion is inappropriate, extreme and persistent, it is classified as pathological. (Laborit , 1993 ). These new techniques, which include the possibility of creating transgenic and knockout animals to investigate the effects of any known gene, are expected to speed up the molecular

dissection of anxiety and ultimately lead to the design of more efficient anxiolytic drugs. (Laborit ,1993 ) 

Neuro – cognitive model of anxiety Neurocognitive models of anxiety propose a common amygdala-prefrontal circuitry that

underlies dysfunctional biases in emotion processing e.g. selective attention to threat, interpretation of ambiguous emotional stimuli and acquisition and extinction of conditioned fear (Bishop, 2007). There is compelling evidence that clinically anxious adults and children, and individuals with sub-clinical levels of anxiety, demonstrate a range of biases in emotion processing; most notably a readiness to selectively attend to threat cues (review by Bar-Haim et al., 2007; Waters et al., 2008) and to interpret emotionally ambiguous stimuli in a negative manner (review by Mathews and MacLeod, 2005). Anxiety and studies The consequences of anxiety during test or examination may limit the educational or vocational development and promotion through the educational system. It is normal for a student to feel anxious before a test or examination, but it becomes problematic when the level of anxiety is excess. The negative effects of anxiety can be explained by two models namely; the Interference and the Learning Deficit Models. According to the interference model, anxious( J. A. Afolayan et al, 2013 ) students are distracted due to task irrelevant cognitions and negative thoughts during examinations, while the learning deficit model proposes that it is student’s ineffective study habits during preparation for an examination that causes them to be anxious .(Bower , Gilligan , Monterio ,1981 ). Causes of anxiety An anxiety condition isn't developed or caused by a single factor but a combination of things. A number of other factors play a role, including personality factors, difficult life experiences and physical health. ( Attwell, 2010)

Family history of mental health conditions

Some people who experience anxiety conditions may have a genetic predisposition towards anxiety and these conditions can sometimes run in a family. However, having a parent or close relative experience anxiety or other mental health condition doesn't mean you'll automatically develop anxiety. Personality factors Research suggests that people with certain personality traits are more likely to have anxiety. For example, children who are perfectionists, easily flustered, timid, inhibited, lack selfesteem or want to control everything, sometimes develop anxiety during childhood, adolescence or as adults. Ongoing stressful events Anxiety conditions may develop because of one or more stressful life events. Common triggers include: 

work stress or job change

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change in living arrangements

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pregnancy and giving birth

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family and relationship problems

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major emotional shock following a stressful or traumatic event

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verbal, sexual, physical or emotional abuse or trauma

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death or loss of a loved one.

Physical health problems Chronic physical illness can also contribute to anxiety conditions or impact on the treatment of either the anxiety or the physical illness itself. Common chronic conditions associated with anxiety conditions include: 

diabetes



asthma



hypertension and heart disease

Some physical conditions can mimic anxiety conditions, like an overactive thyroid. It can be useful to see a doctor and be assessed to determine whether there may be a medical cause for your feelings of anxiety.

Other mental health conditions While some people may experience an anxiety condition on its own, others may experience multiple anxiety conditions, or other mental health conditions. Depression and anxiety conditions often occur together. It's important to check for and get assistance for all these conditions at the same time.

Substance use Some people who experience anxiety may use alcohol or other drugs to help them manage their condition. In some cases, this may lead to people developing a substance use problem along with their anxiety condition. Alcohol and substance use can aggravate anxiety conditions particularly as the effects of the substance wear off. It's important to check for and get assistance for any substance use conditions at the same time.

Reference American Psychiatry Association 1994. DSM IV Diagnostic and Statistical - Manual, 4th Edition. American Psychiatric Association: Washington, D.C. Bailey, J.E., 2007. A validation of the 7.5% CO2 model of GAD using paroxetine and lorazepam in healthy volunteers. J. Psychopharmacol. 21 (1), 42–49. Grillon, C., 1998b. Effects of experimental context and explicit threat cues on acoustic startle in Vietnam veterans with posttraumatic stress disorder. Biol. Psychiatry 44 (10), 1027–1036. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. Yali, A. M., & Lobel, M. (1999). Coping and distress in pregnancy: An investigation of medically high risk women. Journal of Psychosomatic Obstetrics & Gynecology, 20(1), 39–52. Albom, M. (1997). Tuesday with Morrie: An old man, young man, and life’s greatest lesson, New York: Doubleday. Bourne, E.J. (2005).Anxiety and phobia workbook. Oakland, CA: New Harbinger Publications. Bronson, P. (2002). What should I do with my life? The true story of people who answered the ultimate question. New York: Random House. Freud, A. (1946). The ego and the mechanism of defence. New York: International Universities Press, Inc. Herman,J.(1997). Trauma and recovery. New York: Basic Books. Schmidt, M.D., Leonard J., & Warner, B.(2002). Panic: Origins, insight, and treatment. Berkeley, CA: North Atlantic Books. Stahl,S.M.(1996).Essential

psychopharmacology:

neuroscientific

applications. Cambridge, MA: Cambridge University Press.

basis

and

practical

Cohen, A. (2008) The primary care management of anxiety and depression: a GP’s perspective, Advances, Psychiatric Treatment 14, 98–105. Clark, D. (2011) Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience, International Review of Psychiatry 23, 375–84. Laborit H.(1993 ) Inhibition of action: Interdisciplinary approach to its mechanisms and physiopathology. Emotion, Inhibition and Health. Seattle, WA: Hogrefe & Huber Publishers. 57–79. Bower, G. H., Gilligan, S. G., & Monteiro, K. P. Selectivity of learning caused by affective states. Journal of Experimental Psychology: General, 1981, 110, 451–473. J. A. Afolayan et al Adv. Appl. Sci. Res., 2013, 4(5):25-33 , 28 Pelagia Research Library) Butler, G., & Mathews(1983), A. Cognitive processes in anxiety. Advances in Behavior Research & Therapy, 51–62. Argote, L., McEvily, B., & Reagans, R. (2003). Managing knowledge in organizations: An integrative framework and review of emerging trends [Electronic version]. Management Science, 49(4), 571-582