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Clinical Psychology and Gerontology

Question:

Discuss about the Clinical Psychology and Gerontology.

Answer:

Introduction:

The areas of the brain affected during the state of fear and anxiety have been determined by neuroimaging research. The objective of the research was to develop new treatment methods for treating patients with clinical anxiety which is almost always associated with fear. Parts of the brain that are involved when a person experiences fear and anxiety are the amygdala, the nucleus accumbens, the hippocampus, the ventromedial hypothalamus,  periaquiductal gray, insular cortex, thalamic nuclei and prefrontal regions of the brain that include the infralimbic cortex (Shin & Liberzone, 2010). The nuclei associated with the amygdala and the brain stem nuclei are also involved. While the amygdala is understood to be involved in the processing of emotion and memory and fear and anxiety (Shioiri, 2010).

Effects on the Brain

Anxiety is often the outcome of the behavioural changes that occur due to anticipatory affective and cognitive factors when a person is faced with an uncertainty about   potential future threat (Grupe & Nitschke, 2013). The uncertainty about a future event makes it difficult for an individual to avoid the event or to mitigate its effect, it leads to anxiety. At times fear may be associated with anxiety.

The experience of anxiety by the brain due to unconditioned stimuli or perception of threat occur due to the role of various parts of the brain. The central role is played by the amygdaloid nuclei which cause the acquisition of fear conditioning. The various physical responses to fear have been understood to be caused by the role that the hippocampus plays in contextual processing. Extinction recall occurs due to processes in the infralimbic cortex. Together these processes form the fear circuitry. The roles of avoiding events that cause anxiety and cognition about components that lead to apprehensive anxiety only in the human beings and this is where the prefrontal cortex regions is likely to be involved.

Effects on the Body

Excessive fear and anxiety can cause the release of the hormone cortisol from the adrenal gland.  Stress hormone that is released by the adrenal gland - cortisol can cause hyperglycemia and an increase in the blood levels of triglycerides so that these can be used as fuel by the body. Inability to sleep, short attention spans and memory issues are the effects of raised levels of stress hormones. Other physical effects on the body are - difficulty swallowing, giddiness, severe headache, general irritability, increased heartbeat, lack of concentration, muscle aches, tense muscles nausea, nervousness, rapid breathing, hyperventilation, profuse sweating, trembling of limbs and twitching. Increased anxiety and fear over a long period of time can cause inability of the immune system to guard the body against infections, an digestive system, tense muscles, inability to recall recent events, premature onset of heart disease, and even heart attack ("How worrying affects your body", n.d.).

Prenatal stress can alter the morphology of brain, cause anxiety-related behaviour, affect coping mechanisms and regulation of the HPA once the child attains adulthood. The behavioural and neuroendocrine responses to stress in individuals can be affected due to differences in regulation of genes that control these factors owing to variations in maternal care (Steimer, 2002).

There are two distinct categories of people-  people who are susceptible to hypnosis and those with a low hypnotic ability. Changes in the brain are experienced only by those people who can get hypnotised and these changes are rather distinct. There is a decrease in activity in the area of brain called the dorsal anterior cingulate. This area of the brain helps a person to decide about what to worry about and what not to be anxious about. The hypnotized people experience an increase in connections between the insula and the dorsolateral prefrontal cortex of the brain. The insula helps in forming a mind body connection while the prefrontal cortex helps in planning and performing tasks. As a result of the mind body connection, during hypnosis it is possible to reduce gastric secretions, alter the heart rate and reduce blood pressure. Even skin conductance can undergo a change. The third change in the brain is the reduction in connections between the prefrontal cortex and the brain's default mode network. Usually this phenomenon in observed in people prone to daydreaming (Jiang, White, Waelde, & Spiegel, 2016).

Apart from reducing anxiety, hypnosis has been found to be effective in reducing pain during surgeries and childbirth. It can help to improve the immune system and raises B-cell and T-cell activity. Hypnosis can alleviate anxiety - related headaches. Patients also report relief from feeling tired and feel relaxed at the end of a hypnosis session. Faster healing of post surgical wounds has been reported after hypnosis of patients undergoing surgery (Ginandes, Brooks, Sando, Jones, & Aker, 2003).

The impact of hypnosis on the body has been used to relieve patients of pain. Though the effect of hypnosis is observed only in those individuals who are capable of getting hypnotised. The pain relief from hypnosis depends on the kind of pain a patient suffers from. Treatment of musculoskeletal pain, for example, lower pain through hypnosis is not successful. But pain caused due to neuropathic and vascular reasons may be relieved through hypnosis. So hypnosis provides a viable alternative for getting relief from pain when t is chronic and does not respond to administration of analgesic drugs (Dillworth, Mendoza, & Jensen, 2012).

In breast cancer patients who receive radiotherapy, there is significant anxiety and subsequent pain. Patients receiving radiotherapy are also anxious  about whether the treatment will lead to relief. A study compared the standard care regime with empathy and hypnosis. Patients who were received hypnotic treatment were the least anxious and reported lesser pain (Mayden, 2012).

In a study that evaluated the health of patients undergoing dialysis, patients reported severe fatigue, anxiety, depression and sleepiness. On being treated with hypnosis the patients reported considerable relief from anxiety, depression and sleepiness. Though they did not derive mush benefit in fatigue, it was experienced to a lesser degree than without hypnosis. 

References

body, H. w. (n.d.). how-worrying-affects-your-body?page=2. Retrieved from http://www.webmd.com: http://www.webmd.com/balance/guide/how-worrying-affects-your-body?page=2

Dillworth, T., Mendoza, M., & Jensen, M. (2012). Neurophysiology of pain and hypnosis for chronic pain. Transltional Behavioral Medicine, 2(1): 65–72.

Ginandes, C., Brooks, P., Sando, W., Jones, C., & Aker, J. (2003). Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. American Journal of Clinical Hypnosis, 45(4), 333-51.

Grupe, D., & Nitschke, J. (2013). Uncertainty and Anticipation in Anxiety. Nture Reviews Neuroscience, 14(7), 488–501.

Jiang, H., White, M., Waelde, L. C., & Spiegel, D. (2016). Brain Activity and Functional Connectivity Associated with Hypnosis. Cerebral Cortex, doi: 10.1093/cercor/bhw220.

Mayden, K. (2012). Mind-Body Therapies: Evidence and Implications in Advanced Oncology Practice. Journal of the Advanced Practitioner in Oncology, 3(6), 357–373.

Shin, L., & Liberzone, I. (2010). The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology, 35(1), 169–191.

Shioiri, T. (2010). Neuroimaging and pathology in anxiety disorders, especially stress-induced fear circuitry disorders]. Nihon Shinkei Seishin Yakurigaku Zasshi, 30(3), 135-9.

Steimer, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues in Clinical Neuroscience, 4(3), 231–249.

Untas, A., Chauveau, P., Dupré-Goudable, C., Kolko, A., Lakdja, F., & Cazenave, N. (2013). The effects of hypnosis on anxiety, depression, fatigue, and sleepiness in people undergoing hemodialysis: a clinical report. International Journal of Clinical and Experimental Hypnosis, 61(4), 475-83.


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