A historically popular research topic in exercise psychology has been the examination of the exercise-anxiety relationship, with an ever-growing literature exploring the link between exercise and anxiety. In addition to its potential for preventing anxiety and anxiety disorders, an increasing number of studies have examined the utility of physical activity and exercise interventions for the treatment of elevated anxiety and clinical anxiety disorders. A National Institute of Mental Health “state-of-the-art workshop” in 1984 was the first significant call put forth that understanding the anxiety-reducing potential of exercise was important and required further investigation. Since the publication of the evidence that came out of that NIMH workshop in Morgan and Goldston’s 1987 book, “Exercise and Mental Health,” a great deal more has been learned yet key aspects of the relationship between exercise and anxiety remain unknown. There is a great deal of work that remains to make good on the “potential efficacy of exercise.”
Steven J. Petruzzello
Nadeeka N. Dissanayaka
Progressive neurological disorders are incurable disorders with gradual deterioration and impacting patients for life. Two common progressive neurological disorders found in late life are Parkinson’s disease (PD) and motor neuron disease (MND). Psychological complications such as depression and anxiety are prevalent in people living with PD and MND, yet they are underdiagnosed and poorly treated. PD is classified a Movement Disorder and predominantly characterized by motor symptoms such as tremor, bradykinesia, gait problems and postural instability; however, neuropsychiatric complications such as anxiety and depression are common and contribute poorly to quality of life, even more so than motor disability. The average prevalence of depression in PD suggest 35% and anxiety in PD reports 31%. Depression and anxiety often coexist. Symptoms of depression and anxiety overlap with symptoms of PD, making it difficult to recognize. In PD, daily fluctuations in anxiety and mood disturbances are observed with clear synchronized relationships to wearing off of PD medication in some individuals. Such unique characteristics must be addressed when treating PD depression and anxiety. There is an increase in the evidence base for psychotherapeutic approaches such as cognitive behavior therapy to treat depression and anxiety in PD. Motor neuron disease (MND) is classified a neuromuscular disease and is characterized by progressive degeneration of upper and lower motor neurons is the primary characteristic of MND. The most common form of MND is Amyotrophic lateral sclerosis (ALS) and the terms ALS and MND are simultaneously used in the literature. Given the short life expectancy (average 4 years), rapid deterioration, paralysis, nonmotor dysfunctions, and resulting incapacity, psychological factors clearly play a major role in MND. Depression and suicide are common psychological concerns in persons with MND. While there is an ALS-specific instrument to assess depression, evaluation of anxiety is poorly studied; although emerging studies suggesting that anxiety is highly prevalent in MND. Unfortunately, there is no substantial evidence-base for the treatment of anxiety and depression in MND. Caregivers play a major role in the management of progressive neurological diseases. Therefore, evaluating caregiver burden and caregiver psychological health are essential to improve quality of care provided to the patient, as well as to improve quality of life for carers. In progressive neurological diseases, caregiving is often provided by family members and spouses, with professional care at advanced disease. Psychological interventions for PD carers addressing unique characteristics of PD and care needs is required. Heterogeneous clinical features, rapid functional decline, and short trajectory of MND suggest a multidisciplinary framework of carer services including psychological interventions to mitigate MND. A Supportive Care Needs Framework has been recently proposed encompassing practical, informational, social, psychological, physical, emotional, and spiritual needs of both MND patients and carers.
Vanessa L. Burrows
Stress has not always been accepted as a legitimate medical condition. The biomedical concept stress grew from tangled roots of varied psychosomatic theories of health that examined (a) the relationship between the mind and the body, (b) the relationship between an individual and his or her environment, (c) the capacity for human adaptation, and (d) biochemical mechanisms of self-preservation, and how these functions are altered during acute shock or chronic exposure to harmful agents. From disparate 19th-century origins in the fields of neurology, psychiatry, and evolutionary biology, a biological disease model of stress was originally conceived in the mid-1930s by Canadian endocrinologist Hans Selye, who correlated adrenocortical functions with the regulation of chronic disease. At the same time, the mid-20th-century epidemiological transition signaled the emergence of a pluricausal perspective of degenerative, chronic diseases such as cancer, heart disease, and arthritis that were not produced not by a specific etiological agent, but by a complex combination of multiple factors which contributed to a process of maladaptation that occurred over time due to the conditioning influence of multiple risk factors. The mass awareness of the therapeutic impact of adrenocortical hormones in the treatment of these prevalent diseases offered greater cultural currency to the biological disease model of stress. By the end of the Second World War, military neuropsychiatric research on combat fatigue promoted cultural acceptance of a dynamic and universal concept of mental illness that normalized the phenomenon of mental stress. This cultural shift encouraged the medicalization of anxiety which stimulated the emergence of a market for anxiolytic drugs in the 1950s and helped to link psychological and physiological health. By the 1960s, a growing psychosomatic paradigm of stress focused on behavioral interventions and encouraged the belief that individuals could control their own health through responsible decision-making. The implication that mental power can affect one’s physical health reinforced the psycho-socio-biological ambiguity that has been an enduring legacy of stress ever since. This article examines the medicalization of stress—that is, the historical process by which stress became medically defined. It spans from the mid-19th century to the mid-20th century, focusing on these nine distinct phases: 1. 19th-century psychosomatic antecedent disease concepts 2. The emergence of shell-shock as a medical diagnosis during World War I 3. Hans Selye’s theorization of the General Adapation Syndrome in the 1930s 4. neuropsychiatric research on combat stress during World War II 5. contemporaneous military research on stress hormones during World War II 6. the emergence of a risk factor model of disease in the post-World War II era 7. the development of a professional cadre of stress researchers in the 1940s and 50s 8. the medicalization of anxiety in the early post–World War II era 9. The popularization of stress in the 1950s and pharmaceutical treatments for stress, marked by the cultural assimilation of paradigmatic stress behaviors and deterrence strategies, as well pharmaceutical treatments for stress.