What do we really know about anxiety?

Anxiety is being diagnosed at extreme levels in the United Kingdom.

£400m was spent on anti-depressants in 2010, 40,000 prescriptions were issued (Harper, 2016).

With COVID-19 leading to the population reducing how often they are leaving their homes, interacting with others and maintaining routines becoming impossible it is expected that this number will grow significantly.

Do you remember the fast beating of your heart, the lump in your throat, feeling weak at the knees? Maybe it was when you pressed the send button for your assignment, maybe when you had to give a presentation at work. This is your fight or flight system warning you that you are facing a threat, not a physical threat, but a possible threat in the future. Maybe you would fail your assignment, or forget what you were saying to your audience. This physical response to an unknown future is called anxiety (Barlow, 2004).

Now, imagine that the physical response, the worry, the feeling of failure is with you more often and your heart is beating so fast that you worry you are having a heart attack, so you drop out of university, you call in sick for your presentation. The anxiety has gripped you so tightly that your life has become torture rather than enjoyable. It keeps you awake until you are worrying about how much you are worrying. This is usually when people will seek help. Where would you go? To the doctor? To a therapist? Maybe both. Maybe you will talk to your friends, if you are not also worrying about what they will think of you.

Different treatments have different evidence bases. Each method used to gather the data gives different evidence. There are two main categories of research; quantitative and qualitative. Through this article I hope you can understand more about how this research affects the understanding of treatments offered.

Would you go to the doctor or the therapist?

Doctors use a medical model based on experimental methods to understand anxiety and treat it. This means that they think you have something biologically wrong inside your body. They use experiments within laboratories to ensure that the ‘magic pill’ works and that it is safe to take. They use scientific equipment to see what is really changing inside your body. The experiments can be replicated again and again with different ‘magic pills’, participants and dosages until they ‘get it right’ (McGrath, 2017).

Cognitive Behavioural Therapists use surveys to understand how the brain works out problems and to see if changing your thought processes could reduce anxiety. Surveys can be anonymous so there is a higher chance of response. They can ask lots of people to contribute and can be used again and again. The information can be analysed easily and interpreted for the public or funders (McGrath, 2017).

Both approaches are the likely ones that you will think of, or be signposted to first, when you feel it is time to seek support.

Both use quantitative methods which:

• Are predetermined – the researchers create a theory and test it to see if they are right (Mahendran, K, 2017b).

• Collect data from performance, attitudes, observations and from analysing secondary (previous) data (Mahendran, 2017b).

• Are explanatory – Use deductive logic; trying out new ideas (Mahendran, 2017a).

• Include experiments, closed question surveys, statistical analysis and structured interviews (Mahendran, 2017b).

• Are commissioned by psychiatrists and pharmaceutical companies with a lot of money and financial power (McGrath, 2017).

Quantitative methods have strengths:

• They control as many potential causes of anxiety as possible (Ness, 2017).

• They are objective, so the emotions of researchers and participants are not involved (Mahendran, 2017b).

• They can be replicated and validated (Mahendran, 2017b).

• They are usually retrospective (Ness, 2017).

They have weaknesses:

• The researcher chooses what is important to look for in anxiety (Carter, 2017).

• The method cannot control everything (Carter, 2017).

• The questions or instructions could be interpreted differently by the participants (Mahendran, 2017b).

• Experiments are not in natural settings (Ness, 2017).

• Surveys and interviews are retrospective. This means that they rely on memory and accurate recall (Ness, 2017).

A link has been found between anxiety and life events such as trauma (Brown et al, 1992) and poverty (Wilkinson and Pickett, 2009). There has been nine times more research commissioned on biological causes as opposed to social causes (Read et al, 2001). Could this be because pharmaceutical companies have the power, knowledge and money to push this research through?

Qualitative methods are useful to gain understanding of anxiety through social causes. Formulations (interpretations) can be made which give a holistic view of the sufferer.

Qualitative methods:

• Are descriptive – Use abductive logic; trying to understand what is happening (Mahendran, 2017a).

• Collect data through interviews, observation and case studies (Mahendran, 2017b).

• Are often used to inform the social approach; social expectations and values (McGrath, 2017).

• Are commissioned by lay people. For example, social services, mental health charities and voluntary organisations (McGrath, 2017).

Qualitative methods have strengths:

• They can give in depth understanding of anxiety and how the participant got there (Mahendran, 2017b).

• They can support a formulation of a person’s life and what areas need addressing; housing, social support network, debt management (Mahendran, 2017b).

• They allow the participants to be involved in what needs to be addressed (Mahendran, 2017b).

They have weaknesses:

• They cannot be replicated very easily, so it is difficult to compare the data (McLeod, 2008).

• They are time consuming (McLeod, 2008).

• There is a significant chance that the researcher and participant will bounce off each other and the data may become an act played out instead of genuine results (Mahendran, 2017b).

Hopefully, this has illustrated that there are many forms of research surrounding anxiety. Each method of collecting information produces different results and these results influence where you go for support and the type of support given. More research needs to be completed on the social factors which can lead to a predisposition for anxiety. Only then can the different methods of collection be accurately compared, although they have given a good starting point for further research.