Anxiety-Based Disorders

  • Ron Acierno
  • Michel Hersen
  • Vincent B. Van Hasselt
Part of the The Springer Series in Adult Development and Aging book series (SSAD)


Barlow (1988) describes anxiety as a “diffuse cognitive-affective structure [at the heart of which] is high negative affect composed of various levels and combinations of activation and arousal, perceptions of lack of control over future events, and shifts in attention to self-evaluative concerns” (p. 235). Along slightly different lines, Wolpe (1990) operationally defines anxiety as “the individual organism’s characteristic pattern of autonomic responses to noxious stimulation” (p. 23). While the former description emphasizes anxiety’s subjective aspects, the latter highlights its overtly measurable (i. e., physiologic) correlates. Importantly, both conceptualizations refer to an experience that is quite common in the general population. Moreover, anxiety is often an appropriate and functional response to a dangerous or frightening situation (e. g., being physically attacked), and facilitates performance of behaviors (e. g., rapid escape) necessary to the survival of an organism. In contrast, excessive or inappropriately experienced anxiety is considered psychopathological when it no longer serves a purpose but instead results in functional impairment.


Anxiety Disorder Obsessive Compulsive Disorder Generalize Anxiety Disorder Social Phobia Panic Disorder 
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  1. Acierno, R., Hersen, M., & Ammerman, R. (1994). Overview of the issues in prescriptive treatments. In M. Hersen & R. T. Ammerman (Eds.), Handbook of prescriptive treatments for adults (pp. 3–27). New York: Plenum Press.Google Scholar
  2. Agras, W. S., Leitenerg, H., & Barlow, D. H. (1968). Social reinforcement in the modification of agoraphobia. Archives of General Psychiatry, 19, 423–427.PubMedCrossRefGoogle Scholar
  3. Allen, R. M. (1986). Tranquilizers and sedative/hypnotics: Appropriate use in the elderly. Geriatrics, 41, 75–88.PubMedGoogle Scholar
  4. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  5. Anthony, J. C., & Aboraya, A. (1992). The epidemiology of selected mental disorders in later life. In J. E. Birren, R. B. Sloane, & G. D. Cohen (Eds.), Handbook of mental health and aging (2nd ed., pp. 28–73). New York: Academic Press.Google Scholar
  6. Arling, G. (1987). Strain, social support, and distress in old age. Journal of Gerontology, 42, 107–113.PubMedCrossRefGoogle Scholar
  7. Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford Press.Google Scholar
  8. Barlow, D. H., O’Brien, G. T., & Last, C. G. (1984). Couples treatment of agoraphobia. Behavior Therapy, 15, 41–58.CrossRefGoogle Scholar
  9. Beck, A. T., Sokal, L., Clark, D. A., Berchick, R., & Wright, F. (1992). A crossover study of focused cognitive therapy for panic disorder. American Journal of Psychiatry, 149, 778–783.PubMedGoogle Scholar
  10. Beers, M. Avorn, J., Soumerai, S. B., Everitt, D. E., Sherman, D. S., & Salem, S. (1988). Psychoactive medication use in intermediate-care facility residents. Journal of the American Medical Association, 260, 3016–3020.PubMedCrossRefGoogle Scholar
  11. Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation: A manual for the helping professions. Champaign, IL: Research Press.Google Scholar
  12. Biran, M., & Wilson, G. T. (1981). Treatment of phobic disorders using cognitive and exposure methods: A self-efficacy analysis. Journal of Consulting and Clinical Psychology, 49, 886–899.PubMedCrossRefGoogle Scholar
  13. Blazer, D., George, L. K., & Huges, D. (1991). The epidemiology of anxiety disorders: An age comparison. In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 17–30). New York: Springer.Google Scholar
  14. Borkovec, T. D., & Sides, J. K. (1979) Critical procedural variables related to the physiological effects of progressive relaxations: A review. Behaviour Research and Therapy, 17, 119.PubMedCrossRefGoogle Scholar
  15. Brickman, A. L., & Eisdorfer, C. (1989). Anxiety in the elderly. In E. W. Busse & D. G. Blazer (Eds.), Geriatric psychiatry. Washington, DC: American Psychiatric Press.Google Scholar
  16. Burvill, P. W. (1987). An appraisal of the NIMH Epidemiologic Catchment Area Program. Australian and New Zealand Journal of Psychiatry, 21, 175–184.PubMedCrossRefGoogle Scholar
  17. Busse, E. (1975).Aging and psychiatric diseases in late life. In M. Reiser (Ed.), American handbook of psychiatry. New York: Basic Books.Google Scholar
  18. Clarke, A. H., & Lewis, M. J. (1982). Fear of crime among the elderly. British Journal of Criminology, 232, 49.Google Scholar
  19. Coryell, W., Noyes, R., & House, J. (1986). Mortality among outpatients with anxiety disorders. American Journal of Psychiatry, 143, 508–510.PubMedGoogle Scholar
  20. Craske, M. G., Rapee, R. M., & Barlow, D. H. (1992). Cognitive-behavioral treatment of panic disorder, agoraphobia, and generalized anxisty disorder. In S. M. Turner, K. S. Calhoun, & H. E. Adams (Eds.), Handbook of clinical behavior therapy (2nd ed., pp. 39–66). New York: Wiley.Google Scholar
  21. Cutler, N. R., & Narang, P. K. (1984). Implications of dosing tricyclic antidepressants and benzo-diazepines in geriatrics. Psychiatric Clinics of North America, 7, 845–861.PubMedGoogle Scholar
  22. DeBerry, S. (1982). The effects of meditation-relaxation on anxiety and depression in a geriatric population. Psychotherapy, Theory, Research, & Practice, 19, 512–521.CrossRefGoogle Scholar
  23. DeBerry, S., Davis, S., & Reinhard, K. E. (1989). A comparison of meditation-relaxation and cognitive/ behavioral techniques for reducing anxiety and depression in a geriatric population. Journal of Geriatric Psychiatry, 22, 231–247.PubMedGoogle Scholar
  24. Dubovsky, S. L. (1990). Generalized anxiety disorder: New concepts and psychopharmacologic therapies. Journal of Clinical Psychiatry, 51(suppl), 3–10.Google Scholar
  25. Eaton, W. W, & Keyl, P. M (1990). Risk factors for the onset of DIS/DSM-III agoraphobia in a prospective, population-based study. Archives of General Psychiatry, 47, 819–824.PubMedCrossRefGoogle Scholar
  26. Eaton, W. W., Kramer, M., Anthony, J. C., Dryman, A., Shapiro, S., & Locke, B. (1989). The incidence of specific DIS/DSM-III mental disorders: Data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatrica Scandinavica, 79, 163–178.PubMedCrossRefGoogle Scholar
  27. Ellis, A., & Dryden, W. (1987). The practice of rational emotive therapy. New York: Springer.Google Scholar
  28. Emmelkamp, P. M., & Wessels, H. (1975). Flooding in imagination vs. flooding in vivo: A comparison with agoraphobics. Behaviour Research and Therapy, 13, 7–15.PubMedCrossRefGoogle Scholar
  29. Famularo, R., Kinscherff, R., & Fenton, T. (1990). Symptom differences in acute and chronic presentation of childhood PTSD. Child Abuse and Neglect, 14, 439–444.PubMedCrossRefGoogle Scholar
  30. Garfinkel, R. (1979). Brief behavior therapy with an elderly patient: A case study. Journal of Geriatric Psychiatry, 12, 101–109.PubMedGoogle Scholar
  31. Garrison, J. (1978). Stress management for the elderly: A psychoeducational approach. Journal of the American Geriatrics Society, 26, 397–403.PubMedGoogle Scholar
  32. George, L. K., Blazer, D. G., Winfield-Laird, I., Leaf, P. J., & Fischbach, R. L. (1988). Psychiatric disorders and mental health service use in later life: Evidence from the ECA Program. In J. Brody & G. L. Maddox (Eds.), Epidemiology and aging (pp. 189–219). New York: Springer.Google Scholar
  33. Gurian, B. S., & Miner, J. H. (1991). Clinical presentation of anxiety in the elderly. In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 31–44). New York: Springer.Google Scholar
  34. Hersen, M. (1981). Complex problems require complex solutions. Behavior Therapy, 2, 15–29.CrossRefGoogle Scholar
  35. Hersen, M., & Ammerman, R. T. (Eds.). (1994). Handbook of prescriptive treatments for adults. New York: Plenum Press.Google Scholar
  36. Hersen, M., & Van Hasselt, V. B. (1992). Behavioral assessment and treatment of anxiety in the elderly. Clinical Psychology Review, 12, 619–640.CrossRefGoogle Scholar
  37. Himmelfarb, S., & Murrell, S. A. (1984). The prevalence and correlation of anxiety symptoms in older adults. Journal of Psychology, 116, 159–167.PubMedCrossRefGoogle Scholar
  38. Jacobson, E. (1938). Progressive relaxation. Chicago: University of Chicago Press.Google Scholar
  39. Jansson, L., & Ost, L. G. (1982). Behavioral treatments for agoraphobia: An evaluative review. Clinical Psychology Review, 2, 311–336.CrossRefGoogle Scholar
  40. Jenike, M. A. (1991). Geriatric obsessive-compulsive disorder. Journal of Geriatric Psychiatry and Neurology, 4, 34–39.PubMedCrossRefGoogle Scholar
  41. Keuthen, N. (1991).Medication and the aging organism: A guide for the non-prescribing clinician. In P. A. Wisocki (Ed.), Handbook of clinical behavior therapy with the elderly client. New York: Plenum Press.Google Scholar
  42. King, C. J., Van Hasselt, V. B., Segal, D. L., & Hersen, M. (1994). Diagnosis and assessment of substance abuse in older adults: Current strategies and issues. Addictive Behaviors, 19, 41–55.PubMedCrossRefGoogle Scholar
  43. Markowitz, P. J. (1993). Treatment of anxiety in the elderly. 145th Annual Meeting of the American Psychiatric Association: Anxiety: Special problems and new approaches (1992, Washington, DC). Journal of Clinical Psychiatry, 54(suppl), 64–68.Google Scholar
  44. Marshall, W. L. (1985). The effects of variable exposure in flooding therapy. Behavior Therapy, 16, 117–135.CrossRefGoogle Scholar
  45. Matt, G. E., Dean, A., Wang, B., & Wood, P. (1992). Identifying clinical syndromes in a community sample of elderly persons. Psychological Assessment, 4, 174–184.CrossRefGoogle Scholar
  46. McCarthy, P. R., Katz, I. R., & Foa, E. B. (1991). In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 197–209). New York: Springer.Google Scholar
  47. Meichenbaum, D. (1974). Self-instructional strategy training: A cognitive prosthesis for the aged. Human Development, 17, 273–280.PubMedCrossRefGoogle Scholar
  48. Myers, J. K., Weissman, M. M., Tischler, G. L., Holzer, C. E., Leaf, P. J., et al. (1984). Six-month prevalence of psychiatric disorders in three communities: 1980–1982. Archives of General Psychiatry, 41, 959–970.PubMedCrossRefGoogle Scholar
  49. O’Brien, J. (1978). The behavioral treatment of a 30-year smallpox obsession and handwashing compulsion. Journal of Behavior Therapy and Experimental Psychiatry, 9, 365–368.CrossRefGoogle Scholar
  50. Ost, L. G. (1988). Applied relaxation vs. progressive relaxation in the treatment of panic disorder. Behaviour Research and Therapy, 26, 13–22.PubMedCrossRefGoogle Scholar
  51. Ost, L. G., Lindahl, I. L., Sterner, U., & Jerremalm, A. (1984). Exposure in vivo vs. applied relaxation in the treatment of blood phobia. Behaviour Research and Therapy, 22, 205–216.PubMedCrossRefGoogle Scholar
  52. Raj, B. A., Corvea, M. H., & Dagon, E. M. (1993). The clinical characteristics of panic disorder in the elderly: A retrospective study. Journal of Clinical Psychiatry, 54, 150–155.PubMedGoogle Scholar
  53. Ray, W. A., Griffin, M. R., Schaffner, W, Baugh, D. K., & Melton, L. J. (1987). Psychotropic drug use and the risk of hip fracture. New England Journal of Medicine, 316, 363–369.PubMedCrossRefGoogle Scholar
  54. Robins, L. N., Heizer, J. E., Weissman, M. M., Orvaschel, H., Gruenberg, E., Burke, J. D., et al. (1984). Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry, 38, 381–389.CrossRefGoogle Scholar
  55. Rowan, V. C., Holburn, S. W., Walker, J. R., & Siddique, A. (1984). A rapid multi-component treatment for an obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 15, 347–352.PubMedCrossRefGoogle Scholar
  56. Salzman, C. (1991). Pharmacological treatment of the anxious elderly patient. In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 149–173). New York: Springer.Google Scholar
  57. Scogin, F., Rickard, H. C., Keith, S., Wilson, J., et al. (1992). Progressive and imaginai relaxation training for elderly persons with subjective anxiety. Psychology and Aging, 7, 419–424.PubMedCrossRefGoogle Scholar
  58. Sheikh, J. I. (1991). Anxiety rating scales for the elderly. In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 251–266). New York: Springer.Google Scholar
  59. Sheikh, J. I. (1992). Anxiety and its disorders in old age. In J. E. Birren, R. B. Sloane, & G. D. Cohen (Eds.), Handbook of mental health and aging (2nd ed., pp. 410–432). New York: Academic Press.Google Scholar
  60. Singh, A. N., & Beer, M. (1988). A dose range-finding study of buspirone in geriatric patients with symptoms of anxiety. Journal of Clinical Psychopharmacology, 8, 67–68.PubMedCrossRefGoogle Scholar
  61. Sklar, M. (1978).Gastrointestinal diseases in the aged. In W. Reichel (Ed.), Clinical aspects of aging. Baltimore: Williams & Wilkins.Google Scholar
  62. Starkstein, S. E., Cohen, B. S., Fedoroff, P., Parikh, R. M., Price, T. R., & Robinson, R. (1990). Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury. Archives of General Psychiatry, 47, 246–251.PubMedCrossRefGoogle Scholar
  63. Stoudemire, A., & Moran, M. G. (1993). Psychopharmacologic treatment of anxiety in the medically ill elderly patient: Special considerations. 144th Annual Meeting of the American Psychiatric Association: Treatment strategies for complicated anxiety (1991, New Orleans, LA). Journal of Clinical Psychiatry, 54(suppl), 27–33.PubMedGoogle Scholar
  64. Thompson, T., Mitchell W., & House, R. (1989). Geriatric psychiatry patient’s care by primary care physicians. Psychosomatics, 30, 65–72PubMedCrossRefGoogle Scholar
  65. Thyer, B. (1981). Prolonged in vivo exposure therapy with a 70 year old woman. Journal of Behavior Therapy and Experimental Psychiatry, 12, 69–71.PubMedCrossRefGoogle Scholar
  66. Thyer, B., Parrish, R. J., Curtis, G. C., Nesse, R. M., & Cameron, O. G. (1985). Ages of onset of DSM-III anxiety disorders. Comprehensive Psychiatry, 23, 113–122.CrossRefGoogle Scholar
  67. Turnbull, J. M. (1989). Anxiety and physical illness in the elderly. Symposium: Anxiety: The silent partner (1989, San Francisco, CA). Journal of Clinical Psychiatry, 50(11, suppl), 40–45.PubMedGoogle Scholar
  68. Uhlenhuth, E. H., Balter, M. B., Mellinger, G. D., Cisin, H., & Clinthorne, J. (1983). Symptom checklist syndromes in the general population: Correlations with psychotherapeutic drug use. Archives of General Psychiatry, 40, 1167–1173.PubMedCrossRefGoogle Scholar
  69. Weiss, K. J. (1994). Management of anxiety and depression syndromes in the elderly. Journal of Clinical Psychiatry, 55(suppl), 5–12.PubMedGoogle Scholar
  70. Weissman, M. M., Leaf, P., Blazer, D. G., Boyd, J., & Florio, L. (1986). The relationship between panic disorder and agoraphobia: An epidemiological perspective. Psychopharmacology Bulletin, 43, 787–791.Google Scholar
  71. Williams, S. L., Turner, S. M., & Peer, D. F. (1985). Guided mastery and performance desensitization treatments for severe acrophobia. Journal of Consulting and Clinical Psychology, 53, 237–247.PubMedCrossRefGoogle Scholar
  72. Williamson, D. S., & Ascione, F. R. (1983). Behavioral treatment of the elderly. Behavior Modification, 7, 583–610.PubMedCrossRefGoogle Scholar
  73. Williamson, J., & Chopin, J. M. (1980). Adverse reactions to prescribed drugs in the elderly: A multicenter investigation. Age and Aging, 9, 73–80.CrossRefGoogle Scholar
  74. Wisocki, P. A. (1991). Behavioral gerontology. In P. A. Wisocki (Ed.), Handbook of clinical behavior therapy with the elderly client New York: Plenum Press.Google Scholar
  75. Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.Google Scholar
  76. Wolpe, J. (1977). Inadequate behavior analysis: The Achilles heel of outcome research in behavior therapy. Journal of Behavior Therapy and Experimental Psychiatry, 8, 1–3.CrossRefGoogle Scholar
  77. Wolpe, J. (1990). The practice of behavior therapy (4th ed.). New York: Pergamon Press.Google Scholar
  78. Wolpe, J., & Flood, J. (1970). The effect of relaxation on the galvanic skin response to repeated phobic stimuli in ascending order. Journal of Behavior Therapy and Experimental Psychiatry, 1, 195.CrossRefGoogle Scholar
  79. Yesavage, J. A., Sheikh, J., Tanke, E. D., & Hill, R. (1988). Response to memory training and individual differences in verbal intelligence and state anxiety. American Journal of Psychiatry, 145, 636–639.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Ron Acierno
    • 1
  • Michel Hersen
    • 2
  • Vincent B. Van Hasselt
    • 2
  1. 1.Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonUSA
  2. 2.Center for Psychological StudiesNova Southeastern UniversityFort LauderdaleUSA

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