Preface

Chapter 8 **Joint Hypermobility, Anxiety, and Psychosomatics — The New**

Chapter 9 **Anxiety in Natural and Surgical Menopause — Physiologic and**

Chapter 10 **A Systematic Review of Anxiety Disorders following Mild,**

Chapter 11 **Impact of Anxiety and Depression Symptoms on Scholar**

**Development in Anxiety Disorders 243**

Chapter 13 **Practical Applications of Complementary and Alternative**

Chapter 14 **Yoga for Anxiety Management in the Workplace 285** S. Doria, F. Irtelli, R. Sanlorenzo and F. Durbano

> **Post-traumatic Stress Disorder 307** Delia M. Podea and Karol J. Wild

**Behavioral Therapy 325**

Chapter 15 **Mindfulness — New Research and Treatment Directions in**

Chapter 16 **Anxiety — Is There an App for That? Considering Technology, Psychiatry, and Internet-Assisted Cognitive**

David Gratzer, Faiza Khalid-Khan and Sarosh Khalid-Khan

Chapter 12 **The Role of Expectations in Treatment Outcome and Symptom**

Michelle Albicini and Audrey McKinlay

Guillem Pailhez, Juan Castaño, Silvia Rosado, Maria Del Mar Ballester, Cristina Vendrell, Núria Mallorquí-Bagué, Carolina Baeza-

Juan Francisco Rodríguez-Landa, Abraham Puga-Olguín, León Jesús Germán-Ponciano, Rosa-Isela García-Ríos and Cesar Soria-Fregozo

**Moderate and Severe TBI in Children and Adolescents 199**

**Performance in High School and University Students 225** Blandina Bernal-Morales, Juan Francisco Rodríguez-Landa and

Theodora E. Katerelos, Claude Bélanger, Marie-Christine Payette, Ghassan El-Baalbaki, André Marchand and Michel Perreault

**Therapies in Adults and Youth with Anxiety Disorders 269** Sarosh Khalid-Khan, Faiza Khalid-Khan and David Gratzer

**Neuroconnective Phenotype 147**

Velasco and Antonio Bulbena

**Therapeutic Bases 173**

**VI** Contents

Frank Pulido-Criollo

Two years after the preceding book on anxiety (New Insight into Anxiety Disorders, InTech, 2013) but also following others published by InTech in the previous years, here we are again with some updates on anxiety disorders. Someone will ask why we speak again of anxiety, considering anxiety disorders as "secondary disorders." Let us describe some epidemiologi‐ cal data, showing the vastity of the phenomenon and suggesting the social impact of it.

According to WHO epidemiological data, mental disorders account for the third leading cause of disability-adjusted life years (DALYs), with a 15.2% of prevalence, following cancer (15.4%) and cardiovascular diseases (26.6%). The global burden of these noncommunicable diseases comprises 81.3% of all disease burden [1]. In the mental health domain, anxiety dis‐ orders rank sixth (4% of all years lived with disability, YLD) in the contribution to chronic conditions in Europe, neuropsychiatric disorders being the first in the whole cause of all YLD [2].

The economic consequences of these health losses are equally large; a recent study estimated that the cumulative global impact of mental disorders in terms of lost economic output will amount to US\$ 16.3 million between 2011 and 2030 (data from the World Economic Forum, the Harvard School of Public Health, The global economic burden of non-communicable diseases, Geneva, World Economic Forum, 2011).

There are more facts that account for the importance attributed to mental illnesses, in partic‐ ular, their very early ages of onset (AOO) compared to other medical illnesses [3]. WMH analyses show that early-onset mental disorders are significant predictors of the subsequent onset and persistence of a wide range of physical disorders and that mental disorders begin‐ ning in childhood-adolescence have significant adverse effects on subsequent role transi‐ tions, being associated with high levels of role impairment [4,5].

According to the recent WHO global survey of 26 countries, anxiety disorders as a whole are the most common among mental disorders, with a 12-month prevalence of 2.4%–18.2% (de‐ pending on the country surveyed), much greater than mood disorders (ranging from 0.8% to 9.6%) which are ranked second.

In a 2004 European epidemiological survey, anxiety accounted for 13.6% prevalence (versus 13.9% for mood disorders), being a leading cause of psychiatric morbidity [6]. In a similar study, average prevalence estimates for any anxiety disorder in the 12 months prior to as‐ sessment are 10.6% and, in a lifetime, 16.6%; women have generally higher prevalence rates than men, the magnitude of the difference varying in different contexts [7].

The USA data are more impressive than European ones; anxiety disorders accounted for 28.8% lifetime prevalence, much greater than mood disorders (20.8%) [8].

In more recent works, anxiety disorders are ranked first in epidemiological surveys all over the world, ranging from 4.8% to 31% lifetime prevalence and from 3% to 19% 12-month prevalence estimates [9].

Even if a recent meta-analysis showed a significant data dispersion mainly due to methodo‐ logical bias and different survey instruments, the data globally confirmed that anxiety disor‐ ders are common, early-onset, and very debilitating [10].

These data are sufficient to maintain clinical attention to anxiety as a disorder. In the previ‐ ous book, we described the evolutionary importance of anxiety and some other "normal" aspects of it and also the neurobiological basis of its pathological manifestations and some other clinical aspects.

In this new book, we were oriented in giving some more neurobiological data of specific anxiety disorders, in particular, PTSD, which is growing in interest due to its relation to modern civilization problems (terrorism, local wars, natural and unnatural disasters). But our interest being a clinical one, we selected representative works on psychosomatic (the relationship of psychological function/dysfunction and the body dysfunctions), in particu‐ lar, the ones related with immunology.

It is well described how anxiety heightens cardiovascular morbidity risks [11], cardiovascu‐ lar mortality (well more than depression alone) [12], but less known to lay public are the data linking anxiety to specific psychosomatic aspects.

This new book is not organized in sections as the preceding one, but the chapters have a logical path. Beginning from the recent evidence on risk factors (neurobiological but also environmental and developmental), not forgetting sex differences in clinical expression of anxiety disorders, the contributing authors put some remarks on psychobiology of panic and give some new issues on genetics of PTSD (with a possible future clinical application of genetic screening) and on neurophysiology of anger in PTSD – a forgotten but impressively important dimension of this pathology.

Anxiety disorders are highly comorbid, the comorbidity being the norm rather than the ex‐ ception, with a mean co-morbidity index of 74.1%, not only fulfilling different anxiety disor‐ ders criteria but also a significant and strong relation with affective disorders (OR 6.6) and substance use disorders (OR 2.4) [13]. From the contributing authors of this book, there emerges also a significant link of anxiety to heightening of suicide risk and with the dramat‐ ically worsening of psychosis.

Following these chapters, we present some data on psychosomatic: a promising linkage be‐ tween anxiety and some immunological dysfunctions (joint hypermobility syndrome), some clinical data on the association between anxiety and menopause (in particular, the one fol‐ lowing surgical procedures), and a particularly interesting feature on the link between in‐ fantile cranial trauma and subsequent anxiety syndromes. In the pre-adult aspects of anxiety, there is a contribution on the influence that anxiety has on scholarly performance.

Finally, the last five chapters are centered on non-pharmacological interventions, specifically on alternative complementary medicine; a contribution is centered on expectancies of psy‐ chotherapies and their role in clinical response (or better, outcome); then a chapter on the review of some alternative approaches to anxiety treatment and their outcomes in specific anxiety syndromes; a chapter on yoga for the treatment of stress in the workplace, which is particularly interesting since the authors present their experiences in applying yoga directly in the workplace; a chapter on the usefulness of mindfulness in treating some forms of anxi‐ ety; and the very interesting last chapter, on the modern approach to psychological treat‐ ment using a mobile app.

So, thanking all the contributing authors, we think we have done a pretty good job to give some up-to-date and useful clinical contributions to anxiety study and treatment.

Hoping to have other books following this, I wish you a good reading.

#### **References**

In more recent works, anxiety disorders are ranked first in epidemiological surveys all over the world, ranging from 4.8% to 31% lifetime prevalence and from 3% to 19% 12-month

Even if a recent meta-analysis showed a significant data dispersion mainly due to methodo‐ logical bias and different survey instruments, the data globally confirmed that anxiety disor‐

These data are sufficient to maintain clinical attention to anxiety as a disorder. In the previ‐ ous book, we described the evolutionary importance of anxiety and some other "normal" aspects of it and also the neurobiological basis of its pathological manifestations and some

In this new book, we were oriented in giving some more neurobiological data of specific anxiety disorders, in particular, PTSD, which is growing in interest due to its relation to modern civilization problems (terrorism, local wars, natural and unnatural disasters). But our interest being a clinical one, we selected representative works on psychosomatic (the relationship of psychological function/dysfunction and the body dysfunctions), in particu‐

It is well described how anxiety heightens cardiovascular morbidity risks [11], cardiovascu‐ lar mortality (well more than depression alone) [12], but less known to lay public are the

This new book is not organized in sections as the preceding one, but the chapters have a logical path. Beginning from the recent evidence on risk factors (neurobiological but also environmental and developmental), not forgetting sex differences in clinical expression of anxiety disorders, the contributing authors put some remarks on psychobiology of panic and give some new issues on genetics of PTSD (with a possible future clinical application of genetic screening) and on neurophysiology of anger in PTSD – a forgotten but impressively

Anxiety disorders are highly comorbid, the comorbidity being the norm rather than the ex‐ ception, with a mean co-morbidity index of 74.1%, not only fulfilling different anxiety disor‐ ders criteria but also a significant and strong relation with affective disorders (OR 6.6) and substance use disorders (OR 2.4) [13]. From the contributing authors of this book, there emerges also a significant link of anxiety to heightening of suicide risk and with the dramat‐

Following these chapters, we present some data on psychosomatic: a promising linkage be‐ tween anxiety and some immunological dysfunctions (joint hypermobility syndrome), some clinical data on the association between anxiety and menopause (in particular, the one fol‐ lowing surgical procedures), and a particularly interesting feature on the link between in‐ fantile cranial trauma and subsequent anxiety syndromes. In the pre-adult aspects of anxiety, there is a contribution on the influence that anxiety has on scholarly performance. Finally, the last five chapters are centered on non-pharmacological interventions, specifically on alternative complementary medicine; a contribution is centered on expectancies of psy‐ chotherapies and their role in clinical response (or better, outcome); then a chapter on the review of some alternative approaches to anxiety treatment and their outcomes in specific anxiety syndromes; a chapter on yoga for the treatment of stress in the workplace, which is particularly interesting since the authors present their experiences in applying yoga directly

prevalence estimates [9].

VIII Preface

other clinical aspects.

lar, the ones related with immunology.

important dimension of this pathology.

ically worsening of psychosis.

ders are common, early-onset, and very debilitating [10].

data linking anxiety to specific psychosomatic aspects.

[1] Global Health Estimates 2014 Summary Tables: DALY by cause, age and sex, by WHO Region, 2000–2012.

[2] Global Health Estimates 2014 Summary Tables: YLD by cause, age and sex, by WHO Region, 2000–2012.

[3] Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. (2007). Age of onset of mental disor‐ ders: a review of recent literature. Curr Opin Psychiatry. 20(4):359–64.

[4] He Y, Zhang M, Lin EH, et al. (2008). Mental disorders among persons with arthritis: results from the World Mental Health Surveys. Psychol Med. 38(11):1639–50.

[5] Ormel J, Von Korff M, Burger H, et al. (2007). Mental disorders among persons with heart disease – results from World Mental Health surveys. Gen Hosp Psychiatry. 29(4):325– 34.

[6] Alonso J, Angermeyer MC, Bernert S et al. (2004). Prevalence of mental disorders in Eu‐ rope: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 109(420):21–7. doi:10.1111/j. 1600-0047.2004.00327.x. PMID 15128384.

[7] Somers JM, Goldner EM, Waraich P, Hsu L (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry. 51(2):100–13. PMID 16989109.

[8] Kessler RC, Berglund P, Demler O, et al. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6):593–602. doi:10.1001/archpsyc.62.6.593. PMID 15939837.

[9] Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. (2009). The global burden of mental disor‐ ders: an update from the WHO World Mental Health (WMH) Surveys. Epidemiol Psichiatr Soc. 18(1):23–33.

[10] Steel Z, Marnane C, Iranpour C, et al. (2014). The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int. J. Epidemiol. 43(2):476–93. doi:10.1093/ije/dyu038.

[11] Roest AM, Martens EJ, de Jonge P, Denollet J. (2010). Anxiety and risk of incident coro‐ nary heart disease: a meta-analysis. J Am Coll Cardiol. 56(1):38–46. doi:10.1016/j.jacc. 2010.03.034.

[12] Martens EJ, de Jonge P, Na B, Cohen BE, Lett H, Whooley MA. (2010). Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary

#### X Preface

heart disease: the Heart and Soul Study. Arch Gen Psychiatry. 67(7):750–8. doi:10.1001/arch‐ genpsychiatry.2010.74.

[13] Michael T, Zetsche U, Margraf J. (2007). Epidemiology of anxiety disorders. Psychiatry. 6(4):136–42.

#### **Dr. Federico Durbano**

SS Psichiatria Territorio e Comunità Dipartimento di Salute Mentale e Neuroscienze A.O. Fatebenefratelli e Oftalmico Milano, Italy
