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Anxiety: Treatment and Relation to the Covid-19 Pandemic

Adam Chalas

Western Michigan University

HSV-2650 Information Literacy in the Health Sc

Virginia Dicken-Gracen

12/4/2023
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Figure 1: Meme image, “Spider-Man’s Pointing Meme” (creator unknown, n.d.)

Covid-19 and Anxiety

The core topic of my research is anxiety and its related disorders. The questions that I had

posed to drive my research are as follows: How did anxiety affect children and young adults

during the Covid-19 pandemic, and what treatments for anxiety have been found to be the most

effective for adults ages 18 and up? I found four articles that I believe hold the answers, at least

in part, to my questions.

First, I looked at how anxiety had affected children and young adults over the course of

the Covid-19 pandemic. Prior to the pandemic, anxiety related disorders were prevalent but at a

much lower rate than we would see post pandemic. There are a lot of reasons as to why this may
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have been the case. We can consider lack of access, the stigma related to anxiety disorders,

general staffing shortages, poor diagnosis and delivery by medical professionals (Hawes, et al.,

2021). All of these instances snowballed into the Covid-19 pandemic and exacerbated an area

that we already had difficulty understanding and treating.

It would seem that all things that had led to lack of care and or diagnosis of anxiety

related disorders in adults and children became far worse during the pandemic for a few reasons.

The lives of everyone across the globe were disrupted without our consent. In school sessions

turned virtual (Liu, et al., 2021), families were unable to meet for holidays, fear mongering and

death tolls were the new normal. A seemingly insurmountable problem had been laid at the feet

of everyone, leaving whatever underlying mental health issues to spring up and flourish amidst

the chaos and uncertainty of the Covid-19 pandemic.

With the rise of many new anxiety related disorders, I looked to find research that could

help combat and treat these conditions. I had found that there are two thoughts on treatment. The

first and most common is Cognitive Behavioural Treatment or CBT, and the others are

considered Relational Therapies or RT (Leonidaki & Constantinou, 2021). CBT focuses on

altering the thought process of the individual when it comes to certain events. For example,

changing the way a person thinks about something that gives them anxiety such as finding a

place to park in a busy downtown area, or perceptively uncomfortable social situations. RT on

the other hand focuses on getting to the root of the problem, trying to determine why the patient

feels the way they do about a certain situation or circumstance. While CBT is more widely used,

studies have shown that patients are less likely to complete a full course of CBT and reap the

benefits of doing so (Leonidaki & Constantinou, 2021). RT however had a much higher rate of

completion, while both yielding the same or similar results (Leonidaki & Constantinou, 2021).
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This means that while CBT stands to be an effective course of treatment for anxiety related

disorders, RT is no slouch and should be considered with as much weight as its contending

course of treatment.

Much of the data surrounding the effectiveness of CBT and RT has been acquired prior to

the Covid-19 Pandemic therefore leaving room for further studies to be conducted regarding the

effectiveness of these techniques post pandemic. I conclude that these particular practices should

still hold value within the current environment due to the nature of the anxiety disorders

themselves. The pandemic certainly took everyone by surprise, but anxiety, depression and other

related disorders were born out of the event. Knowing what we do about current intervention, I

believe we can treat the new rise in anxiety related disorders with confidence given the

opportunity. I also conclude that these courses of treatment can be effective with children and

young adults, albeit adjusted to accommodate the age of the participant.

Information Availability

The information available on my topic questions seems to be plentiful when it comes to

treatment approaches such as CBT and RT. I had no difficulty finding studies supporting these

treatments as viable options for those suffering from anxiety disorders. On the other hand,

finding information that was relevant to the more recent Covid-19 pandemic proved to be more

difficult. I believe that this is due to the recent nature of the pandemic, allowing for little time to

gather and test data effectively. The information that I used came from free sources online,

mostly through the WMU Library search engine.

References
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Cindy H. Liu PhD, Emily Zhang MA, Ga Tin Fifi Wong BA, Sunah Hyun PhD, & Hyeouk

“Chris” Hahm PhD (2020). Factors associated with depressions, anxiety, and PTSD

symptomology during the COVID-19 pandemic: Clinical implications for U.S. young adult

mental health. Psychiatry Research Volume 290 https://doi.org/10.1016/j.psychres.2020.113172

Mariah T. Hawes, Aline K. Szenczy, Daniel N. Klein, Greg Hajcak, & Brady D. Nelson (2021)

Increases in depression and anxiety symptoms in adolescents and young adults during the

COVID-19 pandemic. Psychological Medicine, Volume 52, Issue 14, October 2022, pp.3222 -

3230. https://doi.org/10.1017/S0033291720005358

Venetia Leonidaki, & Matthew P. Constantinou (2021) A comparison of completion and

recovery rates between first-line protocol-based cognitive behavioural therapy and non-

manualized relational therapies within a UK psychological service. Clinical Psychology &

Psychotherapy Volume 29 Issue 2. https://doi-org.libproxy.library.wmich.edu/10.1002/cpp.2669

Rebecca E. Stewart, Dianne L. Chambless (2009). Cognitive-Behavioral Therapy for Adult

Anxiety Disorders in Clinical Practice: A Meta-Analysis of Effectiveness Studies. Journal of

Consulting and Clinical Psychology, Volume 77 Issue 4 https://doi.org/10.1037/a0016032

Appendix A
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Annotated Bibliography

Generalized anxiety disorder. (2023, September 12). Wikipedia

https://en.wikipedia.org/wiki/Generalized_anxiety_disorder

The article includes a definition of Generalized Anxiety Disorder as well as the criteria in

which it is required to be diagnosed with the condition. The article discusses the origin of

anxiety, the course of treatment and prognosis. On the surface, it is a fairly

comprehensive article related to anxiety and cites its sources throughout. While I would

not come to Wikipedia to determine a course of treatment for anxiety, it can certainly

serve as a strong jumping off point. Further research is needed as this source cannot be

solely relied upon due to the nature of Wikipedia.

Harrison Wein, Ph.D (2016) Understanding Anxiety Disorders. NIH News In Health.

https://newsinhealth.nih.gov/2016/03/understanding-anxiety-disorders

This article outlines common anxiety disorders found in both men and women. The

author goes on to discuss trials of Cognitive Behavioral Therapy and its outcomes that

were performed by Susan Whitfield-Gabrieli, a research scientist at the Massachusetts

Institute of Technology. The author, Harrison Wein has a Ph.D in molecular and cell

biology. While not directly correlated to anxiety disorders, he was chosen by the NIH to

write this piece for their newsletter. Further information may be needed as this author is

not directly related to those with anxiety disorders.

NIH National Library of Medicine (2019) How to Help Someone with Anxiety.
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NIH MedlinePlus Magazine.

https://magazine.medlineplus.gov/article/how-to-help-someone-with-anxiety/

This piece is provided by NIH MedlinePlus Magazine. The piece details things to keep in

mind to support someone dealing with anxiety. It states that the approach will vary based

on the person and your relationship to them. Asking questions, listening, and normalizing

their experience is suggested. If necessary, provide resources for support and follow up to

see how they are doing. The piece interviewed David Sommers Ph.D, a Clinical

Psychologist who has been in practice for nearly 29 years. I believe this source is credible

due to the background of David Sommers, being a clinical psychologist, however it is

unclear if he works directly with people who suffer from anxiety and therefore, further

research may be needed.

Cindy H. Liu PhD, Emily Zhang MA, Ga Tin Fifi Wong BA, Sunah Hyun PhD, & Hyeouk

“Chris” Hahm PhD (2020). Factors associated with depressions, anxiety, and PTSD

symptomology during the COVID-19 pandemic: Clinical implications for U.S. young adult

mental health. Psychiatry Research Volume 290 https://doi.org/10.1016/j.psychres.2020.113172

This article aims to identify factors that contributed to the state of mental health for

young adults during the Covid-19 pandemic that began in March of 2020. The study took

place one month after the state of emergency was declared in the United States and lasted

for about one month. The study was done online pulling from social media platforms and

other sources. It used a population size of 898 participants ranging in age from 18 to 30.

They were verified to be human to obtain quality data and were given a 30 minute online

survey. Data was gathered based on the responses to their survey questions. Multiple
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scales were used such as the Connor-Davidson Resilience scale to determine

psychological resilience, the Distress Scale was used to determine the population’s ability

to deal with emotional distress. The Multidimensional Scale of Perceived Social Support

was used to determine the population's perceived social support. The Two-Way Social

Support scale was used to identify the effect of things such as financial support on mental

health. The UCLA Loneliness Scale was used to measure perceived loneliness. The study

also used a new scale that was event specific to Covid-19. Depression was gauged by

using the Patient Health Questionnaire. The Generalized Anxiety Disorder scale was used

to determine anxiety levels, and lastly the PTSD Checklist - Civilian Version was used to

determine the state of PTSD related symptoms. The results showed that reported levels of

anxiety and depression were that of clinical levels, though PTSD-like symptoms did not

appear as prevalent. The study compared previous reports of anxiety and depression

amongst the population and found that a third of that population had higher levels of

anxiety, depression and PTSD than the average numbers outside of the pandemic. The

data reveals that having support from family members was more beneficial to mental

health than the emotional support of friends. Financial related support did not seem to

have an impact on mental health. Certain ethnic groups such as asian-american and latino

had fewer reports of these conditions.. The authors had achieved their goal of identifying

factors that would contribute to the mental health of young adults during the pandemic.

They identified factors such as loneliness, distress tolerance, family support and general

worry related to the happenings of the pandemic. The authors recognize that their

approach limits the ability to determine cause related to the outcomes and they recognize

that their population should not be indicative of a larger population and would hesitate to
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apply these figures to a more broad population

Mariah T. Hawes, Aline K. Szenczy, Daniel N. Klein, Greg Hajcak, & Brady D. Nelson (2021)

Increases in depression and anxiety symptoms in adolescents and young adults during the

COVID-19 pandemic. Psychological Medicine, Volume 52, Issue 14, October 2022, pp.3222 -

3230. https://doi.org/10.1017/S0033291720005358

This study looks at the changes in depression and anxiety related symptoms in the early

stages of the pandemic. The population for this study included 451 adolescents and

young adults living in Long Island, New York. The study used the Children’s Depression

Inventory to measure levels of depression among the population and the Screen for Child

Anxiety Related Symptoms to measure levels of anxiety among the population. The

scales used were followed up by a general “Pandemic Experience Survey” that looked at

and compared their feelings to other natural disasters or man-made disasters. The survey

also looked at five topics including life changes, infection concerns, school concerns,

home confinement concerns, and basic needs concerns. The data was compared with data

that ranged from December of 2014 through July of 2019, to the data that was collected

during this study from March 27th and May 15th of 2020. The study showed an increase

in depression when schools would take great measures related to Covid-19. It also

showed an increase in anxiety when a greater emphasis and enforcement was placed on

social distancing and quarantining at home. The article concludes that there was an

increase in depression and anxiety-like symptoms, the greatest increase was among

women. Social distancing and quarantine were also associated with an increase in

depression and anxiety-like symptoms. The scope of the study is limited to a small
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population and therefore cannot be inferred or applied to a larger population.

Venetia Leonidaki, & Matthew P. Constantinou (2021) A comparison of completion and

recovery rates between first-line protocol-based cognitive behavioural therapy and non-

manualized relational therapies within a UK psychological service. Clinical Psychology &

Psychotherapy Volume 29 Issue 2. https://doi-org.libproxy.library.wmich.edu/10.1002/cpp.2669

The article compares two practices when treating anxiety related symptoms. The first is

cognitive behavioral therapy (CBT) which is more widely used. The second is relational

therapies (RT) which are less widely used. The article states that the study is not

randomized and has a population size of 708 from the ages of 18 to 69 years of age, all of

whom were actively seeking treatment. Of this population, 555 patients undertook CBT

while the remaining 153 patients undertook RT. The range of data pulled from dates

April 1st, 2016 through March 31st, 2017. The main outcomes that were observed fell

into two categories: Treatment Completion and Reliable Recovery. According to the

article, treatment completion occurs when a patient attends at least two sessions. To

determine data scores, the study looks at what they call “Reliable Recovery Rates” using

the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. The article

concludes that on average, patients had completed RT more consistently than CBT.

Though when CBT was completed, it showed about a fourth higher recovery rate than RT

though both appeared to be of similar effectiveness when concluded. The study

determines that although CBT is the preferred and more widely used method of mental

health therapies, RT shows itself to be a contender and should be considered when

approaching mental health treatment. The study determines that more research will need
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to be done to validate these findings amongst a larger population as well as validate its

consistency.

Rebecca E. Stewart, Dianne L. Chambless (2009). Cognitive-Behavioral Therapy for Adult

Anxiety Disorders in Clinical Practice: A Meta-Analysis of Effectiveness Studies. Journal of

Consulting and Clinical Psychology, Volume 77 Issue 4 https://doi.org/10.1037/a0016032

This article takes a look at many different studies to determine the effectiveness of

Cognitive Behavioural Therapy when applied to anxiety related disorders such as

generalized anxiety, depression, and obsessive compulsive disorder. The data found and

analyzed supports the idea that CBT shows an improvement in the participants' outcome,

helping to reduce or eliminate anxiety related disorders. Through this collection of

information, CBT has been shown to produce better outcomes with some anxiety

disorders over others although maintaining the idea that CBT is still effective in either

case. The study looked at research settings versus clinical settings and found that research

settings produced better outcomes, although only slightly, over clinical based settings.

The study also considers the integration of medication into the treatments as well as the

skill of therapists providing services. The study determines that CBT is an effective

treatment for generalized anxiety disorders; however the study also recognizes many

limitations within the way it has quantified and interpreted the data, leading to the idea

that more research and front line testing is required.