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State And Trait Anxiety: A Comparative Analysis Of Drug Therapy

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State and Trait Anxiety: A Comparative Analysis of Drug Therapy

Concerning the Management of Social Anxiety Disorder

by

Christi Alexander Cherrett

ELFN 6773

Introduction to Statistics and Research

Arkansas State University

November 18, 2004

State and Trait Anxiety: A Comparative Analysis of Drug Therapy

Concerning the Management of Social Anxiety Disorder

I. Background of the Problem

Anxiety is an accompanying emotion of stressful encounters. Stress leads to elevated levels of state anxiety and blood pressure, which in turn disposes patients to worse conditions. Stress can be represented by distinct events, such as natural disasters, accidents, migration, divorce, unemployment, surgery, or disease. Persons therefore develop patterns of emotional distress, including anxiety and depression, which can even lead to severe physical events such as myocardial infarct, which is a gross necrosis of the myocardium as a result of insufficient blood supply to the area (Dew et al., 1996; Frasure-Smith et al., 1995; Schwarzer & SchrÐ"¶der, 1997). Individuals with high levels of anxiety are predisposed to a number of ailments. Medically referred to as "somatization", anxiety can result in many other disorders, including tension headache, dyspepsia (difficult or painful digestion), peptic ulcers, and hypertension. In addition, another effect of anxiety is high-risk behavior. For example, anxious individuals either delay or fail to seek health care and avoid screenings that might produce unfavorable or threatening information (HIV testing or mammography screenings). In essence, anxiety is related to ill health in a number of ways and unfortunately most of the research about anxiety is correlational and cross-sectional, which does not allow us to uncover the causal aspects involved in this relationship (Schwarzer, 1990, 1996).

Controversial issues have been associated with the medicines prescribed for anxiety sufferers by general practitioners and psychiatrists. A study was conducted to assess the basic knowledge that sustains the prescription of benzodiazepines also referred to as anti-anxiety drugs. A questionnaire about its use composed of twelve statements which are either "right" or "wrong" was given to a sample of 194 general practitioners and 34 psychiatrists. Results show that although benzodiazepines are commonly used drugs that are safe and effective, experienced health professionals are not in agreement with the current data pertaining to the drugs (de las Cuevas & Sanz, 2004). The research question is, are designer pharmaceutical drugs, such as Sertraline (Zoloft Ð'™), producing global affective anxiolytic results (general relaxation/sedation), or are there differences found between trait and state anxiety.

Anxiety research is conducted with two distinct ways Ð'--as an acute emotion and personality construct, and as a mental disorder or an illness (MacArther & MacArther, 1997). Anxiety research is mainly based on psychometric tools with a major focus on individual differences and qualitative categories with a focus on case studies. Cognitive-behavioral therapy is another basis in the treatment of all anxiety disorders. Exposure to feared situations is necessary to move beyond phobic avoidance and functional impairment to full recovery Ð'--the ultimate goal of therapy (Kjernisted & Bleau, 2004). Those who commonly participate in anxiety studies are those who suffer with Social Anxiety Disorder (SAD). SAD is an early onset, highly chronic, frequently disabling disorder with a lifetime prevalence of approximately 13% (Liebowitz, DeMartinis, Weihs, Londborg, Smith et al., 2003). Sad sufferers fall in one of two categories of anxiety Ð'--state and trait anxiety.

Spielberger (1972, 1983) defines state anxiety as an unpleasant emotional arousal in face of threatening demands or dangers. As such, cognitive appraisal of threat is a prerequisite for the experience of this emotion (Lazarus, 1991). In contrast, trait anxiety reflects the existence of stable individual differences in the tendency to respond with state anxiety in the anticipation of threatening situations. Trait anxiety can also be thought of as a trait that is inherited.

Many instruments have been developed to assess anxiety; however, one measure has stood out over the years Ð'--the State-Trait Anxiety Inventory (STAI) (Spielberger, 1983). While this does not mean that the STAI is an ideal measure, it is the most frequently used scale in research all over the world. The self-report STAI consists of 20 items to assess state anxiety, and another 20 items to assess trait anxiety. These two parts differ in the item wording, in the response format (intensity vs. frequency), and in the instructions for how to respond. The STAI was initially conceptualized by Charles Spielberger as a research instrument for the study of anxiety in adults. It is a self-report assessment device which includes separate measures of state and trait anxiety. According to the author, state anxiety reflects a "transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity". State anxiety may fluctuate over time and can vary in intensity. In contrast, trait anxiety denotes "relatively stable individual differences in anxiety proneness . . ." and refers to a general tendency to respond with anxiety to perceived threats in the environment. It has been reported that trait anxiety is on average higher among lower social class individuals than among middle class individuals (Lewis, 1996; Lenzi et al., 1993; Zeidner, 1988). Furthermore, trait anxiety has been found to be related to individual health. For example, individuals whose self-rating of health is favorable score lower in anxiety (Forsberg & Bjorvell, 1993). Investigations have also examined if gender differences in anxiety-related personality traits exist in patients with panic disorders. Results show that in a total of 101volunteer patients who completed the STAI, there were no distinct gender differences in response scores (Foot & Koszycki, 1995).

Antidepressant therapies have shown significant beneficial effects in the management of anxiety disorders. Situational stressors and anxiety have also been shown

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