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Literature Review: A Holistic View of Anxiety

While anxiety and anxiety disorders have been long discussed within the medical and

psychological fields of study, it wasn’t until very recently that these topics crossed over into

mainstream discourse communities. For years, mental health was perceived as something that

was too taboo to openly discuss in a public setting, causing an intense negative stigma to develop

surrounding any mental health issue. Much of mainstream media and those in older generations

looked at those struggling with their mental health as “broken” or “mentally unstable,” when that

couldn’t be farther from the truth. This harmful perception of mental health forced many people

to suffer silently as they were afraid to seek help or speak to their loved ones about it due to the

possibility that it may make them an outcast. While there are still many areas of the world that

view anxiety and mental health as forbidden topics in family, professional, and academic

settings, there seems to have been a shift in the media that is beginning to change this. This

cultural shift has not just changed how the public perceives anxiety, but also the ways in which

psychologists, psychiatrists, and psychotherapists discuss and treat it. Previously, information

regarding anxiety was largely kept within scholarly and medical discourses, but in recent years,

there has been an urgent call for mental health to be destigmatized, for education on the topic to

be available and accessible to any layperson, and for anxiety disorders to be looked at and treated

multidimensionally, rather than simply relying on medication and psychotherapy. This isn’t to

say that medication and psychotherapy aren’t helpful for some people, because they most

definitely are, but it has been realized that there are more ways to cope with anxiety and various,

less traditional, avenues to explore when attempting to manage an anxiety disorder. This

new-found perspective is what many peer-reviewed articles and research studies lack, but it is
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made up for by current public discourses in the media. This literature review brings together

academic and non-academic sources to create a well-rounded understanding of anxiety and

anxiety disorders, while acknowledging each source’s constraints and bridging the gaps between

them. Independently, each of these credible sources provide relevant and essential information

about anxiety to its audience and serves a specific purpose, but when combined and viewed

holistically, they are able to establish a more comprehensive, twenty-first century perspective on

anxiety.

Murray B. Stein and Jitender Sareen, from the Department of Psychiatry and the

Department of Family Medicine and Public Health at the University of California, San Diego,

wrote the article “Generalized Anxiety Disorder” to educate and inform those in the

psychological, psychiatric, and medical fields of study. This article, which was published in the

New England Journal of Medicine, recognizes a common clinical problem: Generalized Anxiety

Disorder (GAD). After introducing this disorder, the article presents evidence supporting various

strategies of assessment, diagnosis, treatment, and management, followed by a formal review of

their “areas of uncertainty,” concluding with their professional recommendations.1 Published in a

world-renowned medical journal and written by specialists in this field, this article upholds a

strict level of professionalism and formality in its tone, diction, and structure. In her essay,

“Reading Games: Strategies for Reading Scholarly Sources,” Karen Rosenberg notes that

“academics write primarily for other academics”2 and as a scholarly article, “Generalized

Anxiety Disorder” serves to communicate information to those who are primarily in this field of

study and are already familiar with this psychological discourse. This source has a number of

1
Sareen, Jitender and Murray B. Stein, “Generalized Anxiety Disorder,” New England Journal of Medicine 373, no.
21 (November 2015): 2059-2066, https://doi.org/10.1056/NEJMcp1502514.
2
Karen Rosenberg, “Reading Games: Strategies for Reading Scholarly Sources,” In Writing Spaces: Readings on
Writing 2, 2:210–20, 2011.
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constraints, some of which are directly noted in the article. Firstly, this article is targeted towards

a professional audience that already has some knowledge on this topic and is familiar with the

academic and medical jargon used. This makes it much less accessible and comprehensible to a

layperson who may not have experience in this field, leaving them with an idea of what GAD

entails, but most likely lacking what the realistic first steps would be for someone suffering from

GAD or how they can immediately implement changes into their lifestyle that may relieve some

of their anxiety. There is a section of the article entitled “Areas of Uncertainty” in which Sareen

and Stein reveal that it “remains unclear how to best treat patients that have no response or only a

partial response to [the] therapies”3 that were discussed throughout the article. Their trials also do

not consider how alternative therapies and activities such as yoga, meditation, journaling, and

medical marijuana use may play into or alter their results. While this article is a highly regarded,

credible source that provides reliable information regarding the diagnosis, assessment, treatment,

and management processes of GAD, it does not appeal to the larger audience of lay people who

have or may have an anxiety disorder. This article also only includes an American or Western

perspective and it would not be a holistic look at anxiety if we did not consider another culture’s

perspective.

Faiza Amjad and Iram Zehra Bokharey, researchers at the Centre for Clinical Psychology

at the University of Punjab and the Punjab Institute of Mental Health in Lahore, Pakistan, set out

to analyze the correlation between spiritual well-being and coping strategies of patients with

generalized anxiety disorder. Their article “Comparison of Spiritual Well-Being and Coping

Strategies of Patients with Generalized Anxiety Disorder and with Minor General Medical

Conditions” was published in the Journal of Religion and Health. While eastern religions and

western medicine do not always align in their beliefs, this is a particular scenario when a
3
Sareen and Stein, “Generalized Anxiety Disorder,” 2066.
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religious or spiritual perspective has the prospect of bringing something very valuable to western

medicine. Previous studies have discovered that participating in religious or spiritual activities

can correlate to emotional and mental wellness, but it has not yet been studied whether this

spiritual well-being affects one’s coping strategies.4 After introducing the study, Amajad and

Bokharey reveal their definitions of coping strategies, mental health, and spirituality (as well as

how it differs between Western and Islamic belief systems) before stating their method,

procedure, ethical considerations, and the breakdown of their results.5 This peer-reviewed article

offers a very different perspective than all other sources presented in this literature review

because it observes and comments on GAD and mental health from an Islamic perspective with

research conducted in Pakistan. In American society, we do not often think of spirituality and

mental health as having any correlation, but this article underscores how greatly we have

overlooked this and how truly meaningful one’s spirituality can be to their coping skills. At the

end of this article, Amjad and Bokarey express that “the major implication of these findings is

that they have revealed the importance of the effect of spirituality on mental health as well as the

need to develop a therapy module which integrates a spiritual aspect with the existing

bio-psychosocial model,” as well as suggesting that this “allows the patients to conceptualize

their problems from a spiritual perspective, which helps them to gain hope in their life, to take

and accept their responsibilities, and to forgive and to heal the pains of past.”6 The main

constraint of this study is that “spirituality is a subjective experience in which individual

differences exist,”7 meaning that a religious person’s spiritual experience may entirely diverge

from that of someone who grew up atheist. Nonetheless, this unique outlook on mental health is
4
Zahra Bokharey and Faiza Amjad, “Comparison of Spiritual Well-Being and Coping Strategies of Patients with
Generalized Anxiety Disorder and with Minor General Medical Conditions,” Journal of Religion and Health 54, no.
1 (2015): 525, https://doi.org/10.1007/s10943-014-9834-2.
5
Amjad and Bokharey, “Comparison of Spiritual Well Being,” 525-537.
6
Amjad and Bokharey, “Comparison of Spiritual Well Being,”537.
7
Amjad and Bokharey, “Comparison of Spiritual Well Being,”536-537.
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a truly valuable one as it has the capability to change the way that Westerners view their mental

health and ways in which one can manage and treat their anxiety.

Anxiety and anxiety disorders are especially heightened at uncertain and fear-filled times,

so I thought it only appropriate to include a relevant source that addresses this issue as we face a

global pandemic with little to no knowledge of how our future will look. The New York Times

article, “Soothing Anxiety and Stress: Advice From the Year in Well,” captures some noteworthy

aspects of the current conversations surrounding anxiety at a time like this. This article includes a

collection of personal experiences and professional advice about how to reduce stress and soothe

an anxious mind. In each blurb, first-hand experiences, as well as techniques and tools for

reducing anxiety, are shared from the perspective of both psychotherapists and lay people.

Reading how others are effectively reducing their stress and anxiety levels at a time when every

emotion seems to be heightened can feel reassuring, as it may allow you to feel less alone in your

particular situation. It can also enlighten you to test out some new coping strategies and create a

new sense of hope for the future. In one section of the article, psychotherapist, Jenny Taitz

discusses “Five-Minute Coronavirus Stress Resets.” She expresses the importance of

experimenting with these quick coping techniques to find what works best for you, rather than

ignoring the anxiety or worry until it builds up and feels overwhelming.8 She also underscores

that finding what works for you as an individual can feel really empowering and while “these

strategies are not necessarily a cure, [they] can help lower the intensity of overwhelming

emotions, allowing you to recalibrate to better deal with challenges you face.”9 Some of these

strategies that are examined throughout the article include taking short breaks in between work

8
Kari Leibowitz, Alia Crum, Gretchen Reynolds, Jenny Taitz, Jane E. Brody, and Perri Klass, “Soothing Anxiety
and Stress: Advice From the Year in Well.” The New York Times, December 28, 2020,
https://www.nytimes.com/2020/12/28/well/mind/stress-anxiety-advice.html.
9
Jenny Taitz, “Soothing Anxiety and Stress,” The New York Times, December 28, 2020.
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or activities to do a few minutes of meditation or breathing exercises, limiting your time on

social media or exposure to COVID-19 news each day, exercising regularly, as well as finding

the smaller moments of your day that bring you joy and making sure that you do those things

regularly.10 The short blurbs that make up this article bring some very unique viewpoints,

experiences, and advice that when holistically thinking about anxiety and the ways in which one

can improve their mental health during the unsettling and unpredictable time of a global

pandemic. The New York Times is a highly regarded news source and the mass publication of

these first-hand experiences with anxiety, as well as advice about how to get through each day

while isolated during a pandemic, is an extremely powerful way to spread knowledge, promote

better mental health, and create a more understanding and inclusive society. Although

psychotherapy and medication are the traditional, and often first, methods of treatment for

anxiety, there are an abundance of other options and strategies that one can try. Professionally

peer-reviewed articles often do not include what one can do in their day-to-day life when

suffering from anxiety because many of these coping strategies have not been clinically tested,

but they nonetheless can be extremely helpful. These methods of management are more often

found in mainstream media sources such as on YouTube and other social media platforms.

Osmosis is a “powerful health learning platform that aims to build a more caring world

and is used by millions of learners globally.”11 This channel was founded by two medical

students from Johns Hopkins University who wanted to create a more effective and efficient way

to learn medicine, so they decided to launch a learning platform to help medical students, future

nurses, veterinarians, dentists, pharmacists, caregivers, those with health conditions, and so many

more learn and understand sophisticated medical concepts by breaking them down into short,

10
Jenny Taitz, “Soothing Anxiety and Stress,” The New York Times, December 28, 2020.
11
Tanner Marshall and Rishi Desai, Generalized Anxiety Disorder (GAD)- Causes, Symptoms, & Treatment,
YouTube, Osmosis.org, 2016, https://www.youtube.com/watch?v=9mPwQTiMSj8.
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digestible videos. The video, “Generalized Anxiety Disorder (GAD)- Causes, Symptoms, &

Treatment,” was created by Tanner Marshall and reviewed/produced by Rishi Desai, who has a

Master of Public Health degree (MD-MPH) and specializes in mental health. It’s purpose is to

educate and publicly share information about GAD to anyone, of any age, that is interested, on a

platform that is accessible to most people. This video could be used in an educational setting or

for individual purposes because it provides its audience with a wide-range of information about

anxiety that many could find helpful whether they are using it to review for an upcoming test or

are doing personal research because they think they or someone in their life might be suffering

from GAD. This YouTube channel specializes in translating and compartmentalizing complex

health and medical material in a way that allows any lay person to gain a thorough understanding

of the video’s topic. This source presents the same information that is highlighted in the

peer-reviewed article, “Generalized Anxiety Disorder,” but displays it in a way that is

manageable and memorable to any person, whether they have a medical degree or are in middle

school. The strategic use of visual aids throughout the video (i.e. casual drawings that correspond

to the information presented by the narrator)12 are extremely valuable to those watching because

they not only keep viewers engaged but also assist the audience in organizing the information in

their minds. Creating content like this, that is published for free on the internet and is widely

accessible to most people, allows for essential medical and health information to be shared more

evenly across all socioeconomic and education levels. Professionals like Allison Seponara are

making strides towards equalizing information accessibility by sharing this crucial information

on social media and actively working to destigmatize mental health.

Allison Seponara is a licensed therapist with a professional focus on “Anxiety Healing.”

On top of her clinical practice, Allison runs an Instagram account with the goal of making mental
12
Marshall and Desai, “GAD- Causes, Symptoms, & Treatments,” 2016.
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health education and information (specifically about anxiety) available and accessible to the

public. Her Instagram page debunks anxiety myths and stereotypes, discusses new research and

techniques to assist with anxiety and promote better mental health, attempts to break the stigma

against anxiety that has been so prominent in our society, and provides many helpful tips and

tricks to calm your mind and body when anxiety strikes.13 Social media in particular has played a

remarkable role in creating a more open and accepting perspective on mental health that is

centered on education, understanding, and acceptance. By posting content on a platform that

virtually everyone has access to, it generates a wide-ranging audience of people with varying

ages and backgrounds. Similarly to the Osmosis YouTube channel, this style of education was

created to be easily accessible and understood by any person who may come across it, but where

Allison’s content diverges from the Osmosis GAD video is that her information is broken down

into even smaller bite-sized pieces for the public to digest. This method of education through

social media posts has established a culture of learning-on-the-go and allows Allison’s content to

be easily shared and reposted time and time again with the potential to reach thousands, or even

millions, of people. As previously mentioned, the article, “Generalized Anxiety Disorder,”

demonstrates the diagnosis, treatment, and management processes in a highly professional,

academic fashion, while this non-academic source is centered on providing lay people with

helpful information about anxiety through eye-catching graphics, with little to no psychotherapy

jargon that would be found in academic sources. Common topics that she covers in her posts

include, “15 Warning Signs Someone’s Anxiety is Setting In”; “10 Struggles of Having Anxiety

and Being ‘High Functioning’”; and “Self-Soothing Activities to Help When Anxious.” 14 Allison

shares knowledge that is directly applicable to those who suffer from anxiety, as well as those

13
Allison Seponara, “15 Warning Signs Someone’s Anxiety is Setting In; 10 Struggles of Having Anxiety and Being
‘High Functioning’; Self-Soothing Activities to Help When Anxious,” Instagram, 2021.
14
Allison Seponara, “Anxiety,” Instagram, 2021.
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who have loved one with anxiety. By disseminating these realistic techniques and debunking

anxiety myths on a public platform, she spreads awareness about anxiety and anxiety disorders,

which, in turn, has the ability to destigmatize mental health. While this source greatly contrasts

the format, style, and purpose of the academic articles presented in this literature review, they

have each proven to be valuable to their particular audiences, but when this information is

considered collectively it can be even more powerful.

In isolation, each of these sources proves to be credible due to the professional and/or

first-hand experiences of the writers, giving them authority on the topic, and their ability to

captivate their particular audience with accurate and applicable information about anxiety and

anxiety disorders. Each source effectively serves to educate, enlighten, heal, share, or inform, but

when analyzed collectively, they create a much more holistic view of anxiety and the struggles

that come with it, as well as what one can do to better themselves and their mental health when

suffering from anxiety. This literature review not only presents readers with professionally

written peer-reviewed articles about the clinical procedures for the diagnosis, treatment, and

management of anxiety, but also with feasible steps that they can utilize in their everyday life to

help relieve some of the anxiety that they or a loved one may feel. These sources in combination

debunk anxiety myths, work to destigmatize mental health issues that have been long overlooked

by the public, share helpful advice and techniques to effectively cope, disseminate knowledge on

a topic once thought of as too taboo to discuss in any public forum, and view anxiety

multidimensionally while considering the wide variety of treatment options, rather than solely

relying on medication and psychotherapy to heal one’s anxiety. Bringing together academic and

non-academic sources in this literature review acknowledges each source's constraints and

bridges these gaps, while establishing a functional and relevant twenty-first century perspective
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on anxiety that can be utilized by both lay people and those in the psychological and medical

fields.
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References

Amjad, Faiza, and Iram Zehra Bokharey. “Comparison of Spiritual Well-Being and Coping

Strategies of Patients with Generalized Anxiety Disorder and with Minor General

Medical Conditions.” Journal of Religion and Health 54, no. 2 (2015): 524–39.

https://doi.org/10.1007/s10943-014-9834-2.

Leibowitz, Kari, Alia Crum, Gretchen Reynolds, Jenny Taitz, Jane E. Brody, and Perri Klass.

“Soothing Anxiety and Stress: Advice From the Year in Well.” The New York Times.

The New York Times, December 28, 2020.

https://www.nytimes.com/2020/12/28/well/mind/stress-anxiety-advice.html.

Marshall, Tanner, and Rishi Desai. Generalized Anxiety Disorder (GAD)- Causes, Symptoms, &

Treatment. YouTube. Osmosis.org, 2016.

https://www.youtube.com/watch?v=9mPwQTiMSj8.

Rosenberg, Karen. “Reading Games: Strategies for Reading Scholarly Sources.” In Writing

Spaces: Readings on Writing 2, 2:210–20, 2011.

Sareen, Jitender and Murray B. Stein. “Generalized Anxiety Disorder.” New England Journal of

Medicine 373, no. 21 (November 2015): 2059-2068.

https://doi.org/10.1056/NEJMcp1502514.

Seponara, Allison. “15 Warning Signs Someone’s Anxiety is Setting In; 10 Struggles of Having

Anxiety and Being ‘High Functioning’; Self-Soothing Activities to Help When Anxious.”

Instagram, 2021.