Individual Differences, Mental Well-being, and Anxiety Disorder: A Case Study Analysis

Mental Health Case Study Essay

Introduction: Mental Health Case Study Essay

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Individual differences can be defined as distinctive behavioral trait that remains consistent over time in different situations. It describes the psychological differences present between people. Mental well-being improves the capability of a person to manage stressful situations in life and improve their abilities to perform and contribute well in society. Many factors, such as mood disorder, psychotic disorder, and anxiety, can affect mental well-being. This assignment would shed light on explaining and exploring the conditions faced by HY. HY is passionate and has a good relationship with the family, but his recent experiences have been worsening his condition. He has been in emotional distress due to social anxiety. This essay will look at multiple types of research that look at personality disorders from both a psychological and biological standpoint. This article will offer a comprehensive assessment of HY’s mental health and distress encounters, diagnosis, interpretations, and solutions, affecting his daily life as a music teacher.

In this assignment, potential exploration and interpretation of the case study will be made to identify the situation of HY. The identification of the issues would help in the possible explanation of it and related consequences. The assignment would also evaluate the causes that have led to the experiences, thoughts, and behavior of HY. This would further illustrate the effective diagnosis methods supported by justification. This would also benefit in determining the possible treatment and support options given to HY to relieve his condition of emotional distress and social anxiety. The models will analyze HY’s experiences, discuss potential contributing factors, and provide support and recommendations. The discussion in this assignment would be supported with the help of theories to present a critical perspective and link them with real-life scenarios. The leading problems that precipitate a propensity to psychosis are also considered, focusing on rigorously analyzing any environmental or hereditary components.

A potential interpretation of the case study

The case study revolves around illustrating the case study of HY, who is a 41-year-old music teacher. HY is very passionate about teaching and music. He secured a senior position at school and recently has been provided with a new probationary role at the school, teaching different classes. It has been decided that if he succeeds at this position, he will be provided with a senior position and pay raise. Despite being happy, this has created an anxious feeling in HY, and due to this, he gets easily frustrated with the students (Porcelli, 2020). Moreover, for the past two months, HY has been experiencing certain symptoms such as chronic fatigue, headache, palpitations, and constant anxious feeling. The conditions experienced by HY are getting worse day by day, resulting in the emergence of emotional distress and social anxiety in HY. This has impacted my ability to be patient and concentrate on HY. It is evident that anxiety leads to heart palpitations and increases irritability in an individual (Taheri Zadeh et al. 2021). This can also lead to the emergence of mental health disorder that impacts the ability of an individual to work and perform well in their respective fields.

The conditions experienced by HY have also been affecting his relationship with his family. Though he has a better relationship with all the members of his family, his recent conditions have made him irritable and distant from his family. The reason behind this is the feeling of social anxiety in HY. He feels inferior to his older brother and finds himself less attractive and successful as compared to him. This is because HY parents have valued safe and secure careers instead of supporting ambition and music. As mentioned by Spain et al. (2018), social anxiety can be caused by negative experiences, humiliation, and family history. This might be the reason behind the inferior feeling and anxious feeling experienced by HY. This aspect has also been explained with the help of the “cognitive-social model of Bandura”. This model represents social anxiety as self-efficiency. From the viewpoint of Abdullah et al. (2019), this model states that self-belief plays a critical role in human cognition, behavior, and motivation. 

HY's doctor has not ruled out any specific illness in him; however, his overwhelming success at school has resulted in emotional distress, and he is skeptical that he might ruin everything in life due to an undiscovered physical illness. This has increased their feelings of worry, rumination, and fear of losing their skill in HY. The reason behind this experience is because of the anxiety faced by HY. It is known that anxiety detracts a person from life and impairs their ability to think clearly and realistically (Bonlor, 2019). HY is also suffering from the same condition, which is making him think and feel unrealistic scenarios, thereby affecting his mood and making him frightened and uneasy. It is because of this condition that he has distanced himself from his family and feels inferior.

Explanation of the issues

The interpretation of the case study has led to the identification of the issues experienced by HY. It has been identified that the major issue faced by HY has been social anxiety and anxious feelings, which has resulted in increasing the negative thoughts and emotions in HY. As mentioned by Emmelkamp, Meyerbröker & Morina (2020), social anxiety has been considered the most common disorder of anxiety that results in negative impacts on all aspects of people's lives. It is also considered a chronic anxiety disorder that is characterized by intense feelings of fear in social; and functional situations. Similarly, Shnier et al. (2022) describe that this disorder leads people to think that they would be judged by other people for their actions and behavior and thus avoid them.

A similar situation can be observed for HY as he has been surrounded by negative thoughts that his overwhelming success might be ruined because of an undiscovered physical illness. This has elevated the feeling of fear and frequent rumination in him as he thinks that he might lose his job as a result of his temperament. This has also impacted my performance and concentration at work. It is because of the mentioned condition and increased fear of HY that his irritability has increased, and he has stopped involving himself with his family and feels inferior. This situation can be better explained with the help of the “emotional dysregulation model”. This model states that triggering events in combination with existing diathesis can result in negative and positive effects based on the effective style of the person (Everaert & Joormann, 2019). The anxious and uneasy feelings faced by HY are the result of emotional dysregulation.

Social anxiety disorder is a type of anxiety disorder that leads to avoidance and fears in social settings and can interrupt life, relationships, daily school, work, and other activities routines. HY's anxious feelings and pain have lately made him easily frustrated with his students when they struggle with their learning, indicating high levels of irritability (Bonlor, 2019). Irritability is a typical social anxiety symptom, particularly during anxiety attacks. Individuals who suffer from extreme anxiety are typically easily disturbed, which indicates that people close to them, either figuratively or literally, have a high risk of prompting them to lash out. It is worth noting that self-esteem is critical in social anxiety development. Negative ideas, such as when one believes they are unpleasant or feel insufficient to be around, make them feel more worried, and individuals with low self-esteem are more prone to negative thoughts.

Individuals with frequent dread are considered uninteresting, awkward, and boring by those they engage with. Such discoveries are significant to those who suffer from social anxiety. People’s opinions may result in a loss of reputation, disagreement, or rejection (Spain et al. 2018). While this possible diagnosis could explain HY’s symptoms, social anxiety disorder also produces difficulty breathing, increased heart rate, and muscle tension. HY may be just starting to show signs of positive social anxiety disorder.

It increases the consequences of negative mood in an individual and reduces the advent of positive thought. This condition is also characterized by inferior feelings, anxiety, and conflictual relationships (Rogersbh.org, 2022). This behavior leads to emotional distress, as experienced by HY. As mentioned by Everaert & Joormann (2019), frequent negative thinking leads to reduced positive appraisal, resulting in an increased risk of anxiety and depression. It is because of this condition that HY has been feeling chronic fatigue, palpitations, and headaches in HY. As defined by Clery et al. (2022), chronic fatigue is a complicated disorder that results in extreme fatigue for a long time hindering the mental and physical activity of the person. Based on the evaluation made, it can be said that the extreme mood of HY has been dragging him to increased social anxiety, and if not treated at the right time, it can affect his career and relationship with HY severely.

It needs to be considered that the combination of biological, social, and psychological consequences affects an individual. Therefore it is necessary to consider the entire aspect and evaluate the situation of humans to improve their psychological problems. The cognitive models and patterns impart focus on many aspects and state the core of social anxiety lies in fear of negative evaluation. Emotional disorder and fear of social fear impact the individual belief about themselves. These negative assumptions lead the individual to feel emotional tension and have an inferior feeling about themselves. The same situation has been faced by HY because of past events in life and the success of his older brother; he feels inferior, and this leads to increased anxious feelings in HY. Increased negative thoughts have increased the tension of HY and have drained its physical and mental energy resulting in the condition of chronic fatigue.

Possible causes for patient's experiences, thoughts, and behaviors

The present case study is developed on the continuous mental issues faced by HY, a music teacher. In the analysis of the case study that is identified the patient suffered from “chronic fatigue, palpitations, headaches, frustration, lower self-esteem and anxiety”, which resulted in emotional distress. As per the view of Livazovi? & Ham (2019), anxiety is the main cause of emotional distress, which happens due to work stress or trauma. On the other hand, both personal and environmental factors are responsible for the development of emotional distress in a person. Therefore in the present case, HY faced issues due to buying in the professional area about his ability which impacted his self-esteem. According to the view of Noor et al. (2021), “feelings of depression, anxiety, or emotional numbness and declining performance” are common symptoms of emotional distress. In the case of HY, those signs are seen that directly impact emotional distress. 

The complexity in diagnosis can be revealed when assessing if HY is suffering from social anxiety and fear of situations with the Liebowitz Social Anxiety Scale (LSAS), which is both valid and reliable. The Liebowitz Social Anxiety Scale (LSAS) is a self-report scale created by Dr. Michael R. Liebowitz, a researcher and psychiatrist. LSAS is a 24-item that can determine how social anxiety affects your life in various scenarios (Noor et al. 2021). The instrument is critical in research projects to identify the degree of social anxiety that the participants experience in medical settings to examine specific symptoms by the patients or by persons who are afraid that their symptoms are evidence of social anxiety.

The personality of a person is a cause of such mental illness, such as in the case of an oversensitive personality resulting in a quick mental breakdown. In the analysis of personality of HY, he reduced his confidence, which impacted his performance in school. On the other hand, “experiencing traumatic events, experiencing racism or discrimination, financial difficulties, working disability and behavioral issues in working area” are some possible causes of mental distress (Mayoclinic.org, 2021). Therefore in the critical analysis of the present case, that is identified where he facade loneliness and irritation for behavioural issues of the working area. Additionally, “social anxiety” is identified in the personality of the patient by analysis of his behavior where he has a difficult relationship with his brother. According to the view of Chaves-Filho et al. (2019), “self-rejection, negative experiences, family history of rejection and bullying” are identified as some causes of social anxiety. In the analysis of the present cases, “self-rejection and bullying” are identified as the causes of social anxiety.

The LSAS is graded by adding the item ratings together, whereby the questions are answered based on how the previous week's events influenced the participants. Like any other self-report instrument, the Liebowitz Social Anxiety evaluation measures should be analyzed by a skilled mental health professional and, if necessary, followed up with a comprehensive diagnostic interview for social anxiety disorder. The LSAS has been established in studies to be a cost-effective and efficient approach to determining patients with social anxiety issues.

The most common approaches to diagnosis used by psychiatric professionals are the International Classification of Diseases ICD-10 and the Diagnostic and Statistical Manual of Mental Disorders. The International Classification of Diseases (ICD) is a structure that involves gathering, analyzing, categorizing, and presenting mortality data that enhances international comparison (Koyuncu et al. 2019). It includes establishing a standard format for giving details about mortality on death certificates. The categorization framework and choice and modification criteria in the current revised ICD, issued by the World Health Organization, are then used to change the presented diagnoses into medical codes.

The patient lowers his confidence due to the success of his brother, with whom he has tried to apply risk and become more ambitious to achieve success. Such feelings of failure increase the risk of self-harm as he has applied risk to feel comfortable. As stated by Goldin et al. (2021), “family conflict, trauma or abuse, bullying, and rejection” are the causes of social anxiety, which results in behavioral changes and reduced quality of work. On the other hand, the analysis of feelings of HY's shows that he has suffered from the present mental illness, and rejection and family conflicts are common causes. According to the view of Koyuncu et al. (2019), fear, embarrassment, and humiliation are common behavioral symptoms of social anxiety. The patient has faced the fear of losing his job or his temper over the students, which is a symptom of social anxiety, and those are increased complications of mental distress.

The “Self-Determination Theory” is an effective theory for understanding the mental and emotional needs of a person. Those needs play an important role in development, well-being, and satisfaction, whereas the opposite happens and causes mental distress. As per the view of Vasconcellos et al. (2020), “autonomy, competence, and relatedness” are basic psychological needs of a person that cause health benefits. On the other hand, self-rejection and rejection in the workplace affect the needs of the patient, which increases the risk of mental distress. In the critical analysis that is identified, HY feels anxious due to the presence of mental distress caused by family conflicts that reduced his confidence and performance in the workplace. According to the view of Emmelkamp, Meyerbröker & Morina (2020), increased stress in the workplace may result in social anxiety and mental distress in a person. In the present case, his responsibility increases as he has the responsibility of teaching different classes, which raises his work stress. [Refer to appendix]

The increased working stress and family conflicts developed anxiety for HY, which impacted his performance and increased his fear of the loss of his job. According to the view of Ormstad et al. (2020), “anxiety disorder, brain structure, and negative environment” can cause complications such as social anxiety. A negative environment where the patient faced rejection about his ability to work raised his controlling behavior and developed a risk of social anxiety. Besides this, as risk factors, family conflicts are present where he reduced his self-estimation and those increased risk factors of mental distress and social anxiety. According to Chaves-Filho et al. (2019), less support from the family and continuous rejection develop mental distress and social anxiety in a person. In the critical analysis of HY's situation, chronic fatigue and anxiety were identified, which developed due to raised work stress. He has fear about his new responsibility and job role in the school, which may cause such issues of social anxiety and mental distress.

The fundamental objective of any development in a healthcare plan is to enhance patient care. ICD-10 considerably improves the amount of detail, approving for improved measurement of medical safety and value. Comprehensive data analytics assist policymakers, administrators, managers, and healthcare practitioners in enhancing better policies, reducing risks, practical procedures and structures, and developing better standards (Safadi et al. 2022). ICD-10 offers healthcare management the information they need to figure out how much time and money they have spent treating a particular medical condition. Therefore, it gives them more extraordinary decision-making powers, allowing them to allocate resources more wisely and attain positive patient outcomes without jeopardizing healthcare quality.

The analysis of behavioral changes, feelings, and experiences of HY identified that the main cause of such anxiety is increased working stress and lower self-esteem due to a complex relationship with his brother. According to the view of Ormstad et al. (2020), chronic fatigue and common anxiety may increase with the development of working stress. On the other hand, lower self-excess of the patient causes anxiety and directly impacts his performance which increases the risk of more mental distress. The fear of losing a job impacted his behaviour and those caused changes in his behaviour which impacted his relationship with students. As per the view of Safadi et al. (2022), “childhood abuse, social isolation, racism, social disadvantage, and stress” are causing anxiety and mental distress. In the present case, stress and lower self-esteem are identified as common causes of anxiety.

The development of frustration is an increased complication of mental distress, which is managed successfully with an adaptation of support and theory. Excessive worry about his new responsibility and frequent termination about losing a job have developed anxiety more. Increased stress impacts his ability which makes him more conscious about activities; additionally, he tries to attempt risk. Therefore, in the critical analysis, excessive stress and fear are causing such mental distress in the patient.

Justification of the diagnosis methods

 According to the developmental and attachment stress model, HY needed to establish a high sense of self-esteem, increase his sense of well-being, lower his stress hormone levels in his blood, quiet his mind, and relax his muscles. Judgment issues, coping skill deficits, typical negative thinking patterns, and decreased emotional intelligence (the ability to express, comprehend, and notice emotions) are all psychological variables that influence social anxiety disorder. A social stressor can induce a medical onset of anxiety through this pathway (Renna et al. 2018). Anxiety can have social and environmental origins that are significantly less obvious than actual trauma. Negative self-evaluation cognitive schemas significantly predict social anxiety disorder with forced social isolation. Moreover, anxiety is exacerbated by a lack of self-esteem.

As per the above explanation, it can be said that HY needs to test for anxiety. This disease includes feelings of fear, nervousness, and anxiety. This condition is different from the normal anxious and nervous feelings and impacts the normal productivity level of a person. As per the case study, the patient is feeling anxious about further achievements and good incidents in their life (Iverson et al. 2019). For the diagnosis of mental disorders like anxiety, it is necessary to rule out possibilities for other physiological conditions that may cause certain symptoms. As proper diagnosis has been done in the case of HY, there are no significant diseases have been found.

Diagnosis of the disorder is mainly based on symptom analysis, to understand its severity and frequency. In the case of HY, the symptoms include chronic fatigue, headache, palpitation, and feeling on the edge. Although there are no certain negative events have been observed recently, the fear of bad following the greater approaches makes him anxious. The Anxiety Symptoms Questionnaire (ASQ) can be used to effectively diagnose the situation. This process involves a self-assessment evaluation of the anxiety symptoms experienced by the patient for a few previous weeks (Baker et al. 2019). This includes a total of 17 segments and helps measure the intensity and frequency of anxiety to understand the overall severity of the disease. For this purpose, the Likert scale can be used for grading the feeling between 0-10. This includes all the major symptoms of anxiety such as irritability, nervousness, worry, irritability, fatigue, pain, and difficulty in concentration (Renna et al. 2018). As per the case study, all the above symptoms have been observed as a major health issue.  The frequency and anxiety assessed for each symptom can be represented through a scoring process that can be summed up for the overall score. Also, this process is reliable for different age groups, gender, and ethnicity.

            Another major diagnosis process that can be applied to this includes utilizing the diagnostic and statistical manual for Mental Disorder 5 (DSM-5). This guideline helps to diagnose and clarification of details for over 70 mental diseases and disorders, and hence develop a certain standard for diagnosis, treatment, and research for professionals (psychiatry.org, 2021). Based on the guidelines, the structured clinical interview for DSM disorder can be utilized for this purpose. As per the case study, the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) can be effective. The structured interview process can be time-consuming and helpful for determining the exclusion and inclusion criteria that are effective for the process (Tolin et al. 2018). As per the case study, the patient is experiencing extreme fatigue, which is associated with depression as well. Also, irritability and feeling on edge are related to depressive disorder. Hence the separation from anxiety and depression is mandatory. This detailed structured interview process helps to understand the interrelation and exclude the possibilities of other mental disorders for the patient. Using the interview method following ASQ can be impressive and increases validation for the diagnosis up to a high extent.

Possible support and treatment options

While discussing the treatment procedure that is effective for treating anxiety disorder, mentioning both pharmacotherapy and psychotherapy is mandatory. Based on the diagnosed severity of the disease, a combination and effective procedures for the treatment can be chosen. Both the drugs and the psychotherapies can be used for the process. The drugs involved in the treatment of the process can be based on the type and severity of the symptoms (Adwas et al. 2019). The medications involve antidepressants, such as escitalopram, paroxetine, venlafaxine, and so on. Apart from that, anti-anxiety medications are also used, such as buspirone. To avoid excessive panic and overthinking mechanisms, sedatives can also be utilized for the purpose. This includes benzodiazepines, which acts as effective sedatives for relief and good sleep pattern.

Apart from the medications, psychotherapies can also be effective for the purpose, which is widely known as psychological counseling (Milne & Munro, 2020). Psychotherapy (also known as talk therapy psychological counseling or talk therapy) or medicines, or a combination of the two, are the most popular treatments for social anxiety disorder. Psychotherapy is a successful treatment, and it may be much more beneficial. The majority of patients with social anxiety disorder benefit from psychotherapy. In therapy, patients learn how to identify and modify negative beliefs about themselves and build skills to enable them to achieve social confidence. Patients suffering from social anxiety disorder learn strategies to change negative thoughts about themselves through psychotherapy. Among different therapies, cognitive behavior therapy is the most recognized and used therapy for anxiety treatment. It guides the management of worries and stresses and helps to return to normal activities. Apart from that, acceptance and commitment therapy, mindfulness techniques, meta-cognitive therapy, physical activity, and exercise are also effective for the purpose.  

The pharmacotherapy mainly includes the calcium channel modulator and Selective serotonin and norepinephrine reuptake inhibitors (SSRI and SNRI). The drugs included in the SSRI are Escitalopram, Paroxetine, and Citalopram. SNRI category includes Venlafaxine and Duloxetine. The anticonvulsant or channel modulator that can be used for this purpose is Pregabalin. The anti-anxiety drug that can be used along with it is Opipramol (Bandelow et al. 2022). The drugs that are used for anti-anxiety purposes are mostly abused and create dependency. Hence proper knowledge of the patient regarding side effects is mandatory. On the other hand, the duration of the treatment needs to be continued to avoid relapse in patient conditions. This can be identified as an effective factor for drug treatment. In the case of SSRI and SNRI, the drugs need to be continued for nearly 6-12 months and observation is needed for ending the acute phase of anxiety (Ströhle et al. 2018). In case of cessation of the drug therapy, gradual degradation of the dosage of medication is needed. As per the use of benzodiazepines for anxiety treatment, a critical discussion of the severity of the symptoms is needed to be considered. It can be used for severe panic and distress conditions for the patient. The usage needs to be limited for patients with cardiac disorders, suicidal tendencies, and other drugs taken.

In the case of anxiety and related disorders, psychotherapy is considered first-line therapy. One of the major therapies that can be used for anxiety control and management includes CBT. Cognitive-behavioral therapy is the most successful form of anxiety psychotherapy, and it can either be used in groups or individually. Exposure-based cognitive behavioral therapy gradually increases an individual's exposure to the circumstances they are most afraid of. The treatment can help them gain the strength to cope with events that induce anxiety and enhance their coping abilities. They can also engage in role-playing or skills training to hone their social skills and acquire courage in interacting with people. Experimenting with social circumstances might be especially beneficial in challenging their fears. This mainly includes the identification of the behavioral patterns that are influenced by negative thoughts and emotions and substituting them with positive thinking, a desirable pattern, and emotional response (Ströhle et al. 2018). In the case of anxiety, the feelings and thoughts are negatively influenced by lower self-esteem, excessive worrying, and nervousness. This creates a negative impact on the behavior and approaches that are used for handling the situation.

CBT mainly helps assess the major stressors and their impact on the person’s life. The thoughts and the anxiety can be further challenged. , Modifications in the behaviors can also be done through the process, through proper utilization of skills and knowledge (Mehta et al. 2019). This method also includes effective knowledge acquisition through journaling and other methods. Knowledge is a helpful approach to overcoming anxiety and nervousness and considering the impacts of the process (Otte, 2022). As per the case study, HY has been anxious over the success factor and its approach to the new job profile. In this case identification of the potential failure factors associated with the process and developing overcoming strategies is the major factor. He may use his skills, knowledge, and experiences from the past as an effective tool for the process.

Following cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT) was created as a "third-wave" method for social anxiety disorder. This process mainly focuses on accepting negative thoughts and stressful feelings to increase commitment towards constructive and healthy activities (Kelson et al. 2019). This can be effective in increasing the psychological flexibility of a person. As anxiety is mainly related to the effective identification and management of the negative thoughts and emotions that generate nervousness and worry this can be an effective approach.  Another treatment process includes meta-cognitive therapy (MCT) for the purpose, which includes changes in the beliefs related to thinking methods. This is a process associated with CBT that includes a change in the thinking process. For proper application of CBT, changes in the thought process are essential. The modification can be easier through the implication of the meta-cognitive process (Nordahl et al. 2018). Hence this process helps to change the set of beliefs associated with the thinking pattern of a certain person. It is mainly used for increasing the effectiveness of the CBT process, and in certain cases, instead of the CBT process. MCT is an effective process though it needs serious practice for challenging the beliefs and dominant thinking process of a person.

Along with the therapies, mindfulness is also an effective process for fighting anxiety. It helps to promote relaxation and further relief from chronic thinking and nervousness. This also helps to provide self-confidence and increase self-esteem through proper thinking patterns and ability. Mindfulness can be gained through meditation, a deep breathing process, and muscle relaxation (Aylett et al. 2018). Listening to songs or pursuing hobbies can also help to provide confidence for a person. Apart from this exercise and physical activity also contribute to overcoming nervousness. Physical activity leads to the release of adrenaline, the feel-good hormone that promotes self-satisfaction. Along with it maintaining a proper diet, sleeping patterns, and a healthy routine is also a necessary factor for overcoming anxiety.

Conclusion

It has been concluded from this assignment that anxiety and anxious feelings can result in increased negative thoughts and fear in an individual. This assignment has focused on the case study and has interpreted it to identify the issues faced by HY. It has been identified that HY sufferers from social anxiety, which has resulted in palpitations, chronic fatigue, anxious feeling, headache, and inferiority complex in HY. This has also affected the concentration and performance of HY in school and society. This explanation of the identified issues have been done, and it has been found that the increased negative thoughts and anxious feeling in HY has resulted in making him irritable and have created a gap between him and his family. The discussion of possible causes has been done, which has resulted in the present situation of HY. It has also justified the approaches that can be taken to improve HY's condition. Pharmacotherapy, CBT, MCT, and psychological therapies have been identified as possible treatment options for HY. The discussion in this assignment has been supported by various theories and models such as the “cognitive-social model of Bandura”, "emotional dysregulation model", "and self-determination theory", and others.

Reference

Abdullah, S. M. (2019). Social cognitive theory: A Bandura thought review published in 1982-2012. Psikodimensia, 18(1), 85-100. 

Adwas, A. A., Jbireal, J. M., & Azab, A. E. (2019). Anxiety: Insights into signs, symptoms, etiology, pathophysiology, and treatment. East African Scholars Journal of Medical Sciences, 2(10), 580-591.https://avys.omu.edu.tr/storage/app/public/haticek/139566/Anxiety.pdf

Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice–a systematic review and meta-analysis. BMC Health Services Research, 18(1), 1-18. 

Baker, A., Simon, N., Keshaviah, A., Farabaugh, A., Deckersbach, T., Worthington, J. J., ... & Pollack, M. P. (2019). Anxiety Symptoms Questionnaire (ASQ): development and validation. General psychiatry, 32(6).

Bandelow, B., Michaelis, S., & Wedekind, D. (2022). Treatment of anxiety disorders. Dialogues in clinical neuroscience. 

Bonlor, A., (2019). 8 Signs Your Anxiety Is Becoming an Issue. Retrieved on: 7^th October, 2022. Retrieved from:

Chaves-Filho, A. J. M., Macedo, D. S., de Lucena, D. F., & Maes, M. (2019). Shared microglial mechanisms underpinning depression and chronic fatigue syndrome and their comorbidities. Behavioural Brain Research, 372, 111975. https://www.sciencedirect.com/science/article/pii/S0166432819302037

Clery, P., Royston, A., Driver, K., Bailey, J., Crawley, E., & Loades, M. (2022). What treatments work for anxiety and depression in children and adolescents with chronic fatigue syndrome? An updated systematic review. BMJ open, 12(1), e051358. https://bmjopen.bmj.com/content/12/1/e051358.abstract

Emmelkamp, P. M., Meyerbröker, K., & Morina, N. (2020). Virtual reality therapy in social anxiety disorder. Current Psychiatry Reports, 22(7), 1-9. 

Emmelkamp, P. M., Meyerbröker, K., & Morina, N. (2020). Virtual reality therapy in social anxiety disorder. Current Psychiatry Reports, 22(7), 1-9.

Everaert, J., & Joormann, J. (2019). Emotion regulation difficulties related to depression and anxiety: A network approach to model relations among symptoms, positive reappraisal, and repetitive negative thinking. Clinical Psychological Science, 7(6), 1304-1318. 

Goldin, P. R., Thurston, M., Allende, S., Moodie, C., Dixon, M. L., Heimberg, R. G., & Gross, J. J. (2021). Evaluation of cognitive behavioral therapy vs mindfulness meditation in brain changes during reappraisal and acceptance among patients with social anxiety disorder: a randomized clinical trial. JAMA psychiatry, 78(10), 1134-1142. Goldin, P. R., Thurston, M., Allende, S., Moodie, C., Dixon, M. L., Heimberg, R. G., & Gross, J. J. (2021). Evaluation of cognitive behavioral therapy vs mindfulness meditation in brain changes during reappraisal and acceptance among patients with social anxiety disorder: a randomized clinical trial. JAMA psychiatry, 78(10), 1134-1142.

Kelson, J., Rollin, A., Ridout, B., & Campbell, A. (2019). Internet-delivered acceptance and commitment therapy for anxiety treatment: systematic review. Journal of medical Internet research, 21(1), e12530.

Koyuncu, A., ?nce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in context, 8. 

Livazovi?, G., & Ham, E. (2019). Cyberbullying and emotional distress in adolescents: the importance of family, peers, and school. Heliyon, 5(6), e01992. https://www.sciencedirect.com/science/article/pii/S2405844019356178

Mayoclinic.org (2021). Social anxiety disorder. Retrieved from: 

Mehta, S., Peynenburg, V. A., & Hadjistavropoulos, H. D. (2019). Internet-delivered cognitive behavior therapy for chronic health conditions: a systematic review and meta-analysis. Journal of Behavioral Medicine, 42(2), 169-187.

Milne, R., & Munro, M. (2020). Symptoms and causes of anxiety, and its diagnosis and management. Nursing Times [online], 116, 10-18.

Noor, N., Urits, I., Degueure, A., Rando, L., Kata, V., Cornett, E. M., ... & Viswanath, O. (2021). A comprehensive update of the current understanding of chronic fatigue syndrome. Anesthesiology and Pain Medicine, 11(3). 

Nordahl, H. M., Borkovec, T. D., Hagen, R., Kennair, L. E., Hjemdal, O., Solem, S., ... & Wells, A. (2018). Metacognitive therapy versus cognitive–behavioral therapy in adults with generalized anxiety disorder. BJPsych open, 4(5), 393-400. 

Ormstad, H., Simonsen, C. S., Broch, L., Maes, M., Anderson, G., & Celius, E. G. (2020). Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites, and the gut-brain axis as possible shared pathways. Multiple Sclerosis and Related Disorders, 46, 102533. 

Otte, C. (2022). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience. 

Porcelli, P. (2020). Fear, anxiety and health-related consequences after the COVID-19 epidemic. Clinical Neuropsychiatry, 17(2), 103. 

psychiatry.org  (2021). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 

Renna, M. E., O'Toole, M. S., Spaeth, P. E., Lekander, M., & Mennin, D. S. (2018). The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta?analysis. Depression and anxiety, 35(11), 1081-1094.

Rogersbh.org, (2022).  What is emotional dysregulation? Retrieved on: 7^th October, 2022. Retrieved from: https://rogersbh.org/emotional-dysregulation-facts

Safadi, J. M., Quinton, A. M., Lennox, B. R., Burnet, P. W., & Minichino, A. (2022). Gut dysbiosis in severe mental illness and chronic fatigue: a novel trans-diagnostic construct? A systematic review and meta-analysis. Molecular psychiatry, 27(1), 141-153. 

Schiweck, C., Piette, D., Berckmans, D., Claes, S., & Vrieze, E. (2019). Heart rate and high-frequency heart rate variability during stress as biomarkers for clinical depression. A systematic review. Psychological Medicine, 49(2), 200-211. https://www.researchgate.net/profile/Deborah-Piette/publication/327188747_Heart_rate_and_high_frequency_heart_rate_variability_during_stress_as_biomarker_for_clinical_depression_A_systematic_review/links/5be953dd92851c6b27b89651/Heart-rate-and-high-frequency-heart-rate-variability-during-stress-as-biomarker-for-clinical-depression-A-systematic-review.pdf

Shnier, N. L., Burton, A. L., Rapee, R. M., Modini, M., & Abbott, M. J. (2022). Psychometric Properties of the State Probability and Consequences Questionnaire for Social Anxiety Disorder. Journal of Anxiety Disorders, 102636. https://www.sciencedirect.com/science/article/abs/pii/S0887618522001098

Spain, D., Sin, J., Linder, K. B., McMahon, J., & Happé, F. (2018). Social anxiety in autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 52, 51-68. 

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(37), 611. 

Taheri Zadeh, Z., Rahmani, S., Alidadi, F., Joushi, S., & Esmaeilpour, K. (2021). Depression, anxiety and other cognitive consequences of social isolation: drug and non?drug treatments. International journal of clinical practice, 75(12), e14949. 

Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., ... & Hallion, L. S. (2018). Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment, 25(1), 3-13. 

Vasconcellos, D., Parker, P. D., Hilland, T., Cinelli, R., Owen, K. B., Kapsal, N., ... & Lonsdale, C. (2020). Self-determination theory applied to physical education: A systematic review and meta-analysis. Journal of Educational Psychology, 112(7), 1444.