CHAPTER ONE

INTRODUCTION

1.1BACKGROUND OF THE STUDY

The researcher’s friend Naomi, a 26year-old student of the university of Ibadan and a part-time

sales representative at Multifix foods was rushed to the clinic with complaints of joint pain

(arthralgia) and intermittent low back pain. When she was asked by the nurse of how she

acquired this low back pain and joint pain, but she couldn’t recall any mechanism of injury. All

she could say was that she has trouble falling asleep at night and is unable to get a good night’s

rest. Naomi often felt “restless” or “on edge”, which she associated with not sleeping.

Naomi was of the habit of constant worrying about her performance in school, her family, and

her mother’s health, who has recently been diagnosed with type 2 diabetes . She recognizes that

her education is more important than any other thing but she can’t also help being bothered about

family affairs and her mother’s illness which has caused her some extreme level of worrying.

Naomi would wake up at night with throbbing headaches and increased heart rate that would last

for a couple hours and most times she feels tense the majority of the day, causing her to feel stiff.

She also has difficulty paying attention in class and finishing her homework.

The researcher went to visit Naomi at the clinic and inquired how she is feeling. But Naomi said

to her that she feels less motivated to do anything recently. “Work is exhausting and demanding”

she said.

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Naomi would spend about 8 to 12 hours working and by the time she get home, she feels

depleted and cannot keep track of what she has been taught at school. This also keeps her on the

edge as she panics about failing or coming out with a pointless CGPA. She also added that she

sleeps late due to the fact that she would want to go back to her books and home work deadlines

and wake up early during week days and by the time the weekend comes, she is beyond

exhausted. Naomi could barely remember the last time she had a social gathering with her

friends. This is what has led and motivated the researcher to write on this project.

In the words of spelberger (2005) described anxiety as a perceived notion of psychological

distress which occurs due to the expectation of a confusing and potentially threatening event. It is

a feeling that students might have especially in school situation where performance really count.

Bouras & Holt (2007) regard anxiety as a general term for several disorder that cause

nervousness, fear, apprehension and worry. In the light of Dokubo(2014), asserted that anxiety is

an unpleasant state of inner tumult often accompanied by nervous behavior such as backward

and forward, stomatic complaint and rumination. It is a feeling of disturbed, uneasiness which

people observed as an out-turn of over-reaction to situation that is subjectively perceived as

menacing.

Reiss, D, Leve, LD, (2013) discovered that when anxiety is mild, it is acceptable and assist to

motivate an individual and prepares the body physically, behaviourally and cognitively to fish

out and act decisively with threats to survival but severe anxiety can be terribly debilitating or

destructive which can affect daily living of an individual lives.

John c. (2016) stated that anxiety is inimical to structure performance in examination. He opined

that anxiety deals decisively with student potentialities. Anxiety is a basic human emotion that

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consists of fear and uncertainty and usually occurs when an individual is convinced that the

event is a threat to one’s self or self-esteem (Sarason 1988).

Generalize Anxiety Disorder is one of the most common psychiatric disorders, occurring in up

to 21% of adults in their lifetime (Keller 2001). As defined in the DSM-5, Generalized anxiety

disorder (GAD) is characterized by excessive anxiety and worry about a number of events or

activities (e.g., work, school performance), which an individual finds difficult to control

(Sanderson 1990). The worry is impairing across varied contexts (e.g., work, home, and social).

Symptoms which are required for diagnosis include feeling restless, being easily fatigued,

difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance.

(American Psychiatric Association, 2000)

According to Mendlowicz and Stein (2000), Generalized anxiety disorder (GAD) is defined as

excessive worry and tension about every day events and problems on most days, for at least six

months, to the point where the person experiences distress or has marked difficulty in performing

day to day tasks. It can be characterized by the following symptoms and signs: increased motor

tension (fatigability, trembling, restlessness, and muscle tension) autonomic hyperactivity

(shortness of breath, rapid heart rate, dry mouth, cold hands, and dizziness); and increased

vigilance and scanning (feeling keyed up, increased startling, and impaired concentration), but

not panic attacks. (Stein, 2014).

With a lifetime prevalence of approximately 5.5% (US National Comorbidity Survey Replication

2001-2003) generalized anxiety disorder (GAD) is one of the most common anxiety disorders

(Kessler 2013). GAD patients suffer from excessive worry and physiological arousal symptoms

such as poor sleep, muscle tension, and irritability ( The disorder causes significant disabilities in

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patients’ lives; for example, GAD is associated with significant impairment in social and general

functioning (Martins, 2019).

According to a World Health Organization (WHO 1994) study, 38% of individuals with GAD

had moderate to severe occupational role impairment, with a mean of 6.3 disability days per

month.

Generalized anxiety disorder (GAD) is also associated with both increased health care utilization

and comorbid health problems (Martins & Davidson 2003). Disability is thus, a significant

problem in GAD. (Davidson, 2003).

Anxiety is one of the major predictors of academic performance. Students with anxiety disorder

display a passive attitude in their studies such as lack of interest in learning, poor performance in

exams, and on assignments. (Ansari. N. 2009).

Working class students studying at the distant learning of the University of Lagos institute faces

many challenges that erupt from meeting demands from work and academics. Students who

attempt to overcome these challenges are prone to develop anxiety disorder. Anxiety is more

prominent among all students in higher education, especially the distant learning institute (DLI)

student of university of Lagos.

Many distant learners face anxiety when they are confronted with the challenges of the inability

to achieve academic success, work satisfaction and social life due to the outline duties and

expectation. However, sometimes, anxiety can encourage student to think more critically about

how to achieve their goals. Although, students cope with anxiety in different ways, but some

may struggle. This may have some effect on their mental health and work life.

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The distance learning institute (DLI) is the organ of the university of Lagos that operates and

coordinates the open and distance learning programs. It has an enhanced status as that of a

faculty in the university. It has its own academic board. It is empowered to formulate its own

policies, employs its own staff and be responsible for academic programme, examinations,

supervise its day-day affairs and generate funds for its operations.

More so, some inquiries have been raised by the natives about the efficacy of distance learning

programme compared to the conventional medium of face to face.

The distance learning institute of the University of Lagoswas established in 1962 with the

population of about one hundred and thirty-one (131) students and thereafter rose to more than

eight thousand (8,000) students as of today. The courses offered were science education and

management courses. One might postulate that since the distance learners are more mature than

the conventional students, they are better and able to supervise their own advancement or

development.

Mindfulness-based interventions (MBIs) have become increasingly recognized as an empirically

supported approach for the treatment of anxiety and mood conditions (Hofmann & Khoury,

2013). MBIs have been officially recommended in National Institute for Health and Care

Excellence (NICE) guidelines for preventing relapse of depression (NICE 2009) and there is

substantial evidence from the past two decades that MBIs are efficacious for treating symptoms

of anxiety disorders and depressive disorders (Hofmann & Khoury, 2013).

Mindfulness-based cognitive therapy (MBCT) is a promising treatment for generalized

anxiety disorder (GAD). Cognitive behavioral therapy (CBT) is currently considered a

first-line treatment for GAD ( Williams & Kuyken 2005).

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Mindfulness is a type of meditation which involves focusing on being aware of any sensations

and feelings in the present moment, without interpretation or judgement. (Schimelpfening 2021).

It is a compassionate type of awareness with a sense of knowing what is happening in the

external and internal world as it is happening.(Taylor & Byford, 2015).

In the present meta-analysis, the overall risk ratio for Generalized anxiety disorder (GAD) in

Mindfulness based cognitive therapy (MBCT) versus controls was 0.65, which indicates that

MBCT is an effective intervention for managing GAD. (Evans & Stowell 2008)

O’Neill Washington (2004) conducted a study of the effect of MBCT on GAD which reported

significant improvement in pathological concerns, stress, quality of life, and a number of other

symptoms that remained after treatment, although the effect size on the improvement of

pathologic concerns was very small. In MBCT, owing to the awareness exercises and being in

the moment as well as awareness of physical sensations and psychological sensations,

participants realize that when they are anxious, their heart rate and respiration changes. By

MBCT, participants focus their attention on their body and thus increase the awareness of the

body, feelings, and thoughts associated with anxiety, which increases the sense of symptom

controllability, leading to anxiety reduction. (Sharma MP, Mao A, Sudhir PM. 2013)

MBCT is effective in the treatment of GAD by integrating elements of philosophy, dialectics,

mindfulness, acceptance, and communication, and taking advantage of mediating as a pivotal

domain, as well as focusing on attention control in the treatment.

MBCT endeavors to show you how to focus your awareness on all your senses.

Meditations regularly use one anchor for your awareness (Dr Patrizia 2013). Without an

anchor, you can just end up thinking, planning, worrying, day-dreaming and so on (Dr

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Patrizia 2013). As a result, MBCT really makes you aware of how busy your mind is and

how it tends to stick to negative thoughts (Patrizia Collard 2013)

This study is focused on generalized anxiety disorder which is a familiar emotion because it is

part of everyone’s experience. Its natural function is to alert us to potential threats, allowing us

to evaluate and respond to them in appropriate ways (Twenge, J. 2000).

1.2 STATEMENT OF THE PROBLEM

Generalized anxiety disorder (GAD) affects 6.8 million adults, or 3.1% of the U.S. population,

yet only 43.2% are receiving treatment. Women are twice as likely to be affected as men.

Generalized Anxiety Disorder (GAD) often co-occurs with major depression. (W.H.O, 2016).

The prevalence of anxiety disorder among adults estimated 19.1% of U.S. adults had any anxiety

disorder in the past year. Past year prevalence of any anxiety disorder was higher for females

(23.4%) than for males (14.3%). (W.H.O, 2003).

A summary of the global and WHO Regional prevalence of these disorders is shown below.

Globally, it is estimated that 4.4% of the global population suffer from depressive disorder,

and 3.6% from anxiety disorder. (W.H.O, 2017).

According to Kessler (2009) in the national co-morbidity survey replication, found that anxiety

disorders as a group were the most prevalent class of disorders (28.8%), while the most prevalent

lifetime disorder was major depressive disorder (16.6%).

In a recent survey of mental disorders in older African Americans, the National Survey of

American Life (NASL; Ford et al., 2007), anxiety disorders were more than twice as prevalent

7
(13.23%) as mood disorders (6.33%) and the most frequently occurring category of psychiatric

illness. Notably, Post-traumatic Stress Disorder (6.19%) and Social Phobia (4.49%) were the two

most prevalent conditions (Ford et al2007)

In the Region of the Americas, it is estimated that more than 58 million people are suffering from

anxiety disorders, 7.7% in the female population, and 3.6% of the male population are estimated

to be suffering from anxiety disorders in 2015. Prevalence in both sexes combined varied by

country from a low of 3.6 % in Mexico to 9.3 in Brazil. (W.H.O, 2019).

In a study, six different types of anxiety were included from a total of 16 studies. The

prevalence of anxiety disorders was ranged from 0.03% (post-traumatic disorder) to 63%

(social phobia). The ranged prevalence of GAD, phobia, social phobia, separation anxiety,

OCD and PTSD was 0.5-23%, 0.7-27%, 4.3-63%, 0.4-17.7%, 0.1-67, and 0.03-1.2

respectively. The overall pooled prevalence of anxiety disorder was 8% [95%CI: 4% to 14%,

I2 = 98.36%, p < 0.001. The overall test of heterogeneity showed significant heterogeneity

[I2 = 98.36%, p < 0.001; however, sensitivity analysis showed none of influential individual

study on the overall effect and no evidence of publication bias from funnel plot and Egger's

test (P < 0.363). (W.H.O, 2019).

The prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates

of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4%

and 29.8%. Substantive factors including gender, age, culture, conflict economic status, and

urbanicity accounted for the greatest proportion of variability. Methodological factors in the final

multivariate model (prevalence period, number of disorders and diagnostic instrument) explained

an additional 13% of variance between studies. The global current prevalence of anxiety

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disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3%

(3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.

Numerous studies reported that the prevalence of anxiety was found to be higher in students

compared to the general public. The most common form of reported anxiety among the general

community was specific phobias with a prevalence rate of 13.2%, followed by social anxiety

disorder (5.8%) and generalized anxiety disorder (GAD) (5.1%). However, the most common

prevalent form of anxiety among students was social phobia with 11.9%, showing an early age of

onset while panic disorder and GAD had somewhat later onset. Another recent systematic

review evaluated the prevalence of depression and anxiety and reported that an estimated

prevalence of anxiety was 35% among college students.

With regard to Saudi Arabia, recent data indicated that the prevalence of anxiety among graduate

and undergraduate medical students was 31.8%; however, the prevalence was higher in first year

students compared to those in other years.

Another study conducted among undergraduate students in the south region of Saudi Arabia

reported a prevalence of 47.2% for mild anxiety, 42.3% for moderate, and 10.5% for severe

anxiety. Similarly, a study conducted in the central region of Saudi Arabia with a multiethnic

sample of medical students from Al Faisal University reported a high prevalence of 63% of

anxiety. (Ramzi 2020)

The existence of anxiety has gained its origin in the life of many adults as well as students in

different settings of their lives. Anxiety disorders are leading causes of disability worldwide

(Craske & Stein 2016). Untreated childhood anxiety can run a long-term course with significant

personal suffering associated with depression, substance misuse and suicidal behavior (Creswell

et al., 2020). Despite the high burden, childhood anxiety goes largely untreated in many

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countries particularly in Low- and Middle-Income Countries (LMICs) like Nigeria (Alonso

et al., 2018).

Empirical studies conducted in Nigeria have shown that that the burden of mental health

problems among medical students at the University of Ibadan is on the increase, especially when

compared with their counterparts in other disciplines, with at least one in four experiencing

anxiety (Sade 2022).

In a new study, researchers discovered an overwhelming academic workload (65.2%) and failure

to meet up with academic expectations had predisposed them to these mental health problems

which are more common in those from polygamous family settings and in the early years of

medical school (200 and 300 levels).

This study, which was conducted to determine the prevalence, pattern and correlates of common

mental health problems (anxiety and depression) amongst medical students of the University of

Ibadan, Nigeria had involved 690 pre-clinical and clinical medical students of the University of

Ibadan.

According to the study, 6.8 per cent of these medical students had both anxiety and depression

while these students’ perceived risk factors for mental health problems were: overwhelming

academic workload (65.2%), failure to meet up academic expectations (64.1%), fear of failing

tests or exams (58.1%), poor financial support (44.6%) and high frequency of tests (36.4%).

In addition, depression was higher among female medical students (females were 1.2 times more

likely to have anxiety when compared to males); those less than 20 years old compared to those

between 20 and 24 years old and those who had repeated a class.

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The level of anxiety amongst married and engaged medical students was also found to be higher

than the prevalence in single medical students. Dental students were found to be 2.1 times more

likely to have anxiety when compared to their counterparts in medicine.

Also, medical students from polygamous family settings were 4.0 times more likely to have

anxiety when compared to those from monogamous family settings. Students in preclinical

classes were 4.1 times more likely to have anxiety as compared to those in the clinical classes.

Ethnicity was also found as a predictor of anxiety with the non-Yorubas 2.0 times more likely

than Yorubas to experience anxiety.

Distance learning is an alternative to regular university education. Distance education serves as a

means of providing education to different categories of learners who would have been denied

access to education if it were to be only conventional mode of learning that prevail. It is the type

of learning that allows learners earn his or her degree (first degree, master’s degree and even

PHD degrees) without regular attendance to the university. In this regard, distance learning is

appropriate for individuals who are interested in working (keeping their jobs) and learning.

Distance education allows students to find convenient time to study without interfering with their

already busy schedule. One can study after work, in the middle of the night or during weekends.

Learning materials and instruction can actually be obtained online at any time. So, working

students can learn as they earn.

This study sought to access anxiety disorder among working class distance learning institute of

the University of Lagos (unilag) by understanding the levels of anxiety be it mild anxiety,

moderate anxiety, severe anxiety and panic level anxiety that have affected working class

distance learners of the University of Lagos.

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Distance education offers an opportunity for learners who are unable to further their education

due to several constraints. Distance education is the perfect solution for learners seeking to

further their career. It provides learners the workableness for additional qualification or degree

while keeping their current job with flexible schedule.

Asides all these beautiful programs, it is an undeniable fact that working class distance learners

begin to experience some form of problems from work life and school activities which is a major

point the researcher is interested in. The researcher tends to investigate the tumors that distant

learning student undergo which is not favorable to a learning situation

Some of the problems confronting distance learners can be viewed under the following:

Adult learners’ time is delimited

by family, work and social
activities that are in competition.
Considering these potential time
allocation conflicts, work-life
balance aims to find the “balance
work and leisure/family activities”
(Bratton & Gold, 2003). The
current need for permanent
12
knowledge update and the spread
of the Information and
Communicatio
Adult learners’ time is delimited
by family, work and social
activities that are in competition.
Considering these potential time
allocation conflicts, work-life
balance aims to find the “balance
work and leisure/family activities”
(Bratton & Gold, 2003). The
current need for permanent
knowledge update and the spread
of the Information and
Communicatio

13
Adult learners’ time is delimited
by family, work and social
activities that are in competition.
Considering these potential time
allocation conflicts, work-life
balance aims to find the “balance
work and leisure/family activities”
(Bratton & Gold, 2003). The
current need for permanent
knowledge update and the spread
of the Information and
Communicatio
Adult learners’ time is delimited by family, work and social activities that are in competition.

Considering these potential time allocation conflicts, work-life balance aims to find the balance

work and leisure/family activities (Bratton & Gold, 2003).

Bring around siblings, spouses or even parents who wants you to help with something or run

errands definitely contributes toward the imbalance and could lead to stress amongst distance

learners. Hence, home and family members or even work life schedules play a role in the

inability to balance work life and school schedules.

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Life meets us all at different levels and as the wise men will say, all fingers are never equal. This

is one of the very reason distance learners’ source for an extra income to be able to meet up with

life expenses. According to the researchers’ motivational story, the researcher’s friend was

exposed to an unexpected situation which led her to source for a job that would help her source

her needs.

1.3 OBJECTIVES OF THE STUDY

The objective of this research work analyse the prevalence of generalized anxiety disorder on

socio-demographic factors of among working class distance learning (DLI) students of the

University of Lagos (unilag). The specific purposes of the study are as follows:

1. To identify the prevalence of generalized anxiety disorder of (DLI) students.

2. To determine the significant difference of scores on generalized anxiety disorder scale

between male student and female students of the distance learning institute (DLI).

3. To determine if there would be a significant difference between the level of education on the

score of generalized anxiety disorder among distance learning institute (DLI) students of

university of Lagos.

4. To identify the significant difference between marital status on the score of generalized

anxiety disorder among distance learning institute (DLI) students of university of Lagos.

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5. To identify the significant difference between age on the score of generalized anxiety

disorder among distance learning institute (DLI) students of university of Lagos.

1.4 SIGNIFICANCE OF THE STUDY

It is expected that the output of this research will be of much benefit to the general public on the

prevalence of generalized anxiety disorder on socio-demographic variables among working class

distance learning institute (DLI) of the university of Lagos (unilag) in our academic lives, work

life and personal lives. This research serves a great benefit and is meant to inform, educate and

sensitize the general public, universities’ administrators and the government on distance

education.

This study aims at creating awareness to the society and general public, and also health services.

1.5 SCOPE OF THE STUDY

The scope for this research is to bring to light the special awareness that generalized anxiety is

taking its form in the lives of working-class distance learners. This study was planned to identify

the prevalence generalized anxiety disorder on socio-demographic factors among working class

distance learning institute of the university of Lagos (unilag).

1.6 OPERATIONAL DEFINITION OF VARIABLES OF STUDY

For the effective purpose of this study, terminologies used will be defined

Generalized anxiety disorder (GAD):

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A disorder characterized by excessive or unrealistic worry, nervousness or uneaseabout two or

more aspect of life (work, social relationships, school, financial matters, etc.) often accompanied

by symptoms such as palpitations, shortness of breath or dizziness.

Distance learning institute (DLI):

Distance education, also known as distance learning, is the education of which students who may

not always be physically present at a school. Traditionally, this usually involved correspondence

courses wherein the student corresponded with the school via mail. Today, it usually involves

online education.

Socio-demographic Factors

These are variables that includes gender, age, level of education, employment status, profession,

marital status, total number of persons living in the house and living arrangements.

1.7 LITERATURE REVIEW

The researcher wants to reviews the works of various scholars who have made an impact or

written something at one point or the other about assessment and management of generalized

anxiety disorder among working class distance learning institute (DLI) of university of Lagos

(unilag). Generalized anxiety disorder shall be considered for literature review.

The American Psychological Association (APA) defines anxiety as an emotion characterized by

feeling of tension, worried thought and physical changes such as increased blood pressure.

Anxiety has been known to cause psychological distress. The symptoms will often include the

following such as restlessness, and a feeling of being on edge uncontrollable feeling of worry,

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increased irritability, concentration difficulties, sleep difficulties, all of these have been known to

have varying effects on home and work life of individuals in the society (APA, 2013).

According to Barlow (2002) anxiety can be defined as a negative mood state that is accompanied

by bodily symptoms such as increased heart rate, muscle tension, a sense of unease and

apprehension about the future.

Anxiety disorders is defined as excess worry, hyper arousal, and fear that is counterproductive

and debilitating. These are some of the most common psychiatric conditions in the Western

world (Simpson et al. 2010).

According to Onwuegbuzie, Jiao, &Bostick, (2004), researchers in the field recognized two types

of anxiety, trait anxiety and state anxiety where trait anxiety is the tendency of each person to be

relatively stable internally and able to respond to anxiety and state anxiety as the temporary

emotional state of the individual, as well as the structure of the intensity that changes and

fluctuates over time. This is a relatively stable and permanent personality trait that is neither

bound to time nor of any specific situation. Anxiety has an adverse effect on learning and

achievement because the anxiety caused in the educational environment tends to be context

specific. Many types of academic-related anxiety have been identified, including computer

anxiety, research anxiety, statistical anxiety, writing anxiety, foreign language anxiety, general

test anxiety and math anxiety.

According to Huberty (2009) he reported that anxiety affect students' behavior, cognition and

physiology. For example, for students with anxiety, high-risk testing can be very difficult.

Anxious students may also suffer from depression.

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Nadeem, Ali, and Zaidi (2012) studied the impact of anxiety on student achievement at the

University of Bahawalpur in Pakistan. An in-depth survey of the results by these analytical data

shows that anxiety has an impact on students' academic performance. The results show that when

anxiety increases, the academic performance of both male and female students’ declines.

According to Tuncay and Uzunboylu (2010) investigated student anxiety and resistance to

learning through distance education. Precisely the study pursued answers to questions such as,

the symptoms of anxiety, the performance of distance learners for distance learning, gender and

the perception of distance learners or any relationship between these factors and why students

did not choose distance learning courses. 120 distance education students from Near Eastern

University were observed, 96 of whom were interviewed. Computer anxiety, language anxiety,

and social anxiety are one of the reasons why students resist distance learning.

Akinsola and Nwajei (2013) conducted a research to explore the relationship between test

anxiety, depression, and academic performance. The results showed that test anxiety, trait

anxiety and depression coexisted and were positively correlated, and negatively correlated with

academic achievement.

Shakir (2014) study focuses to explore the relationship and impact of academic anxiety and

student academic achievement. The academic performance of students with high and low

academic anxiety groups, the academic anxiety group of male and female, the academic anxiety

group of female high school students, and the high anxiety level between male and female

students have significant differences in academic performance and also between the low

academic anxiety groups of male and female students.

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Agboola and Evans (2015) conducted a research to explore the relationship between anxiety and

academic achievement among international students in UK universities. The results of the study

showed that anxiety was significantly associated with academic performance.

Singh (2015) study focused to measure the impact of anxiety on academic achievement of under

graduate students. The study was exploratory and descriptive in nature. It was found that low and

moderate anxiety is positively correlated with academic achievement.

Shibli (2015) conducted a study to explore the effects of anxiety on achievement and

performance of college students. The analysis of responses revealed no significant relationship

with anxiety and achievement.

Rehman (2016) research study focused on exploring the causes of anxiety among Indian higher

education students. The researchers reviewed relevant academic anxiety literature and identified

factors that led to serious academic anxiety. Exploratory research design is used for Ajmal&

Ahmad 71 qualitative analysis. The results show that personal, family, institutional, social and

political factors are considered to be potential threats to students' serious academic anxiety. For

students with severe academic anxiety, various preventive measures can be taken both non-

clinical and clinical.

According to Kessler et al. (2005) the prevalence of anxiety disorders in the United States is

estimated to be 18%, and their annual cost is reported to be $42.3 billion (Greenberg et al. 1999).

In the European Union (EU), over 60 million people are affected by anxiety disorders in a given

year, making them the most prevalent psychiatric conditions in the EU (Wittchen et al. 2011).

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Pursuant to The Global Burden of Disease (GBD) study estimated that anxiety disorders

contributed to 26.8 million disability adjusted life years in 2010. (Whiteford et al. 2013).

Academic discipline

In a contemporary learning environment, there is a certain amount of social pressure and

regulation. Students have to show up on time, with assignment done, and they are guided through

their learning like in an in-person classroom. This means students are accountable to their

teacher and peers to be a productive member of the class.

On the other hand, asynchronous learning doesn’t provide the same sense of accountability, as

students are working through the class material and learning independently. Some students are

self-disciplined and have no problem with the independence of distance learning, while others

may feel a little lost and find it really difficult in creating a routine that could help them keep up

or study and organize their time efficiently.

Health challenges

Our health should be our very major priority and watch word but when an individual is down

health wise, he or she is incapable of functioning efficiently as used to. Hence, this is the

problem some distance learners face based on some health challenges or sickness that would

cause then not to function as they used to in their various jobs or even at academic schedules.

And in this case, anxiety would eventually set in and cause the individual to fret that he or she

might fail academically or fall out of line at work and get dismissed or relieved from their work

duty.

1.8 THEORETICAL REVIEW

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Various opinions have been propounded by different theorist for investigation and assessment of

generalized anxiety disorder. In view of these opinions from different theorist, this research work

is focusing and dwelling on the line of Sharma & Sharma, (2015) who propounded the term

anxiety which is derived from the Latin word “angere,” meaning to cause distress.

According to Lazarus & Folkman, (1984) anxiety has also been defined as a vague,

uncomfortable feeling exacerbated by prolonged stress and the presence of multiple stressors.

According to DSM V, generalized anxiety is anticipation of future threat and is often associated

with vigilance in preparation for future danger and cautious or avoidant behaviors (American

Psychiatric Association, 2013, p. 189).

A study recently done by the Anxiety and Depression Association of America revealed that

seven out of ten adults in the United States experience a moderate level of anxiety or stress daily.

(Beiter et al. 2014).

According to the National Institute of Mental Health, (2013) normative anxiety may include

being concerned about issues such as money, health, or family problems, but those with an

anxiety disorder are extremely worried about these or other things, even when there is little or no

reason to worry about them. They are very anxious about getting through the day, have a

negative outlook, and think that things will go wrong.

According to the American Psychiatric Association, (2013) anxiety disorders feature excessive

fear or anxiety that persists beyond developmentally appropriate lengths of time. These disorders

cause clinically significant impairment or distress in important areas of functioning. The

different types of anxiety disorders are categorized by the type of objects or situations that cause

the anxiety and can have different ages of onset.

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According to Brook & Willoughby, (2015); Goguen, Hiester, & Nordstrom, (2010); Pascarella &

Terenzini, (2005) social anxiety is marked by fear or anxiety of social situations in which

individuals feel that he or she will be scrutinized by others. Social anxiety has been found as a

barrier to (Russell & Shaw, 2009) developing social ties in several studies. This type of anxiety

is found to be more prevalent in college students, ranging from ten to thirty-three percent, when

compared to the general population, ranging from seven to thirteen percent.

According to the American Psychiatric Association, (2013) to meet criteria for anxiety disorder

diagnosis, the individual must experience the excessive anxiety and worry that he or she finds

difficult to control for at least six months to the extent which it causes significant distress or

impairment in functioning. The individual must also experience three or more of these symptoms

such as sleep disturbances, difficulty concentrating, restlessness, fatigue, irritability, and muscle

tension. Many children develop an anxiety disorder when they are young and often go untreated,

causing the symptoms and negative effects to persist and manifest in various forms

According to the National Institute of Mental Health, (2013). Anxiety can also start during the

teen years or young adulthood as peer interaction becomes increasingly important. Symptoms

may get better or worse at different times, and often are worse during times of stress. Young

adults often use maladaptive coping skills such as safety or avoidant behaviors, risk-taking

behaviors, alcohol and drug abuse to try to manage their anxiety alone. Many of these will

reduce the symptoms in the short-term, while continuing to strengthen and maintain the disorder

in the long term. Anxiety disorders are twice as common among females than males.

According to the American Psychiatric Association, (2013). Work and school performances are

often domains that individuals with anxiety persistently and excessively worry about. As

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individuals go from grade school, middle school, high school and then to college, the level of

difficulty increases as well as the level of pressure to perform well. For those with anxiety, this

may cause the anxiety to increase as well. This ripple effect is concerning because anxiety can go

undetected or untreated and continue to affect social, occupational, academic, or other important

areas of functioning. The excessive worry hinders the ability to do things efficiently and in a

timely manner. The time and energy that is spent worrying would leave less time to study or do

homework and negatively affect an individual in many other areas.

According to Holliday et. al, (2016) Culturally, individuals in the United States that are of

European descent are more likely to have an anxiety disorder than those of non-European

descent, such as Asian, African, and Native American. Also, those from developed countries are

more likely to experience an anxiety disorder than those that are from non-developed countries.

Anxiety among college students in the United States has increased from 6.7% in 2000 (American

College Health Association, 2000) to 12.9% in 2013 (American College Health Association,

2013). In 2014, the American College Health Association reported that 23% of college students

reported anxiety as a factor affecting their functioning in the past year.

According to Mahmoud, Staten, Lennie, & Hall, (2015), some longitudinal studies have

demonstrated that untreated anxiety in adolescents and young adults may lead to several

behavioral, physical, and mental difficulties. Hypertension, coronary heart disease, alcohol

dependence, nicotine addiction, depression, and suicidality are some of the complications that

may be experienced by those with untreated anxiety. These difficulties and complications have a

negative impact on those experiencing them and can worsen anxiety, making it a challenging for

students to be successful. Furthermore, untreated anxiety may lead to pathological anxiety

disorders.

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In a study done by Beiter et al. (2015), students living off-campus, transfer students, and

upperclassmen all scored higher on depression, anxiety, and stress scales when compared to

students living on-campus, non-transfer students, and underclassmen.

Also, in a study done by Nail, Christofferson, Ginsburg, Drake, Kendall, McCracken, &

Sakolsky (2015) which surveyed teachers and parents, excessive anxiety has been associated

with academic underachievement, including low grades and academic performance.

According to Ialongo, Edelsohn, WerthamerLarsson, Crockett, & Kellam, (1995) one

longitudinal study found that youth scoring in the top third on a measure of anxious symptoms in

first grade were more likely to score in the bottom third of the sample in academic achievement

in the fifth grade. Completing assignments, concentrating on work, doing homework, getting

good grades, giving oral reports, taking tests or exams, and writing in class are some of the

academic tasks that may indicate overall academic performance.

According to Nail et al., (2015) anxiety can affect all these tasks, but concentrating on work was

found to be the most frequently reported academic difficulty of those with anxiety. These

findings are applicable to the college student population because when anxiety develops in youth

and goes untreated, this can lead to maladaptive coping skills throughout development. For

example, if an individual develops anxiety in elementary, middle, or high school and it is not

treated, they may abuse alcohol or drugs to cope, which can have negative consequences for

many areas of his/her life.

Gougen, (2010), propounded that social anxiety, as well as other forms, may affect students’

ability to engage with faculty and their peers, which can be an important aspect of academic

achievement.

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In another study, by Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, (1983, p. 27) two types of

anxiety, state and trait, were researched, as well each one’s effect on academic performance.

State anxiety is the emotional state of an individual in response to a particular situation or

moment that includes symptoms of apprehension, tension, and activation of the autonomic

nervous system, and can include tremors, sweating, or increased heart rate and blood pressure.

Trait anxiety is the tendency of an individual to respond to stress with state anxiety. It was found

that average state and trait anxiety have a positive effect on academic performance and lead to

good academic performance, but high and extremely high state and trait anxiety leads to poor

academic performance. This finding could indicate that some anxiety might be conducive to

academic achievement, but also that more than average anxiety could be counterproductive.

Many individuals that have symptoms of anxiety also have symptoms of depression.

The special awareness this research work is emphasizing is the theories and studies carried out

by the above mentioned theorist; the researcher wants to examine the theories of anxiety.

1.9 THEORETICAL FRAMEWORK OF THE STUDY

Four theories were stated with a view to explain the four main psychological model and theories

of generalized anxiety disorder (GAD) among working class distance learning institute of the

University of Lagos. These theories include;

1. Cognitive avoidance theory

2. Metacognitive model

3. Intolerance of uncertainty theory

4. Emotional Dysregulation model

1.9.1 Cognitive avoidance theory

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Generalized anxiety disorder (GAD) is characterized by persistent and uncontrollable worry.

According to the cognitive avoidance theory of generalized anxiety disorder (GAD) worry may

function as an effective dampening strategy motivated by intolerance of negative emotional

states.

The origin of cognitive avoidance theory of worry lies in the behavioral theory of worry lie in the

behavioral model of learning of fear, which proposes that fear is acquired through classical

conditioning and maintained through operant processes.

Borkovec and colleagues wondered whether the two-stage behavioral model could provide an

explanation for the persistence of cognitive process of worry in generalized anxiety disorder

(GAD) the cognitive avoidance model begin with the premise that the content of worry focuses

on possible future aversive events that a person would like to avoid. As the perceived threat exist

only in the future, it renders the typical flight-or-fight response available, therefore the only way

of dealing with the threat is through thinking or worry.

This line of reasoning led to the hypothesis that worry may serve an avoidant function which

may be negatively reinforced

Evidence supports the idea that worry is predominately a verbal linguistic activity, with minimal

levels of imagery and that imagery is associated with greater emotional arousal than worry. This

led to the assumption that switching to worry from imaginal mentation results in a dampening of

affective responding, which negatively reinforces worry. In addition, worry interferes with

effective emotional processing and prevents modification of anxious interpretation of mental

stimuli.

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However, it is unlikely that worry is always triggered by imagery, and worry may simply be a

response to intrusive verbal thoughts. It was suggested that generalized anxiety disorder (GAD)

patients may worry about everyday concerns as a means of avoiding thinking about more

distressing topics, primarily related to interpersonal and difficult childhood experiences.

In this model, worry is negatively reinforced because it reduces arousal. However, it may prevent

emotional processing, and it has been shown to incubate intrusive thoughts.

1.9.2 Metacognitive model of Generalized Anxiety Disorder

Wells (1995) developed the metacognitive model of generalized anxiety disorder to explain

cognitive processes associated with pathological worry in adults, particularly the role of positive

and negative beliefs about worry.

The metacognitive model of pathological worry and generalized anxiety disorder (GAD) was

developed from a transdiagnostic information processing theory of psychological disorder called

the self-regulatory executive function model.

The metacognitive model of generalized anxiety disorder (GAD) proposes that patients

strategically use worry to cope with potential future problems. Worry is selected in response to

unwanted thoughts or doubts that typically occur in the form of “what if” questions. The content

of worry in this context generally focuses on themes related to health, interpersonal and other

everyday concerns. Worries of this form have been labelled type-1 worry and are linked to

positive metacognitive beliefs about the usefulness of worry.

Positive meta-cognitive beliefs include beliefs such as “worrying helps me to cope” and “worry

helps me to deal with problems more effectively.” These beliefs are held in clinical and non-

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clinical populations and by themselves do not mean that a person has pathological levels of

worry or generalized anxiety disorder.

Conversely, negative metacognitive beliefs about worrying are pathognomonic of generalized

anxiety disorder (GAD). Negative metacognitive beliefs fall into two domains which are worry is

uncontrollable, and worry is dangerous and harmful.

Activation of negative metacognitive beliefs leads to negative appraisals of worry itself, such

that the person begins to worry about worrying with the effect of increasing anxiety. This form

of worry is called type-2 worry or meta-worry, where the person fears that worry could lead to

losing control of the mind, going crazy, or harming one’s body.

Negative beliefs exacerbate anxiety, which the person interprets as further sup-porting their

concerns, in turn making it more difficult to obtain a stop signal to terminate the worry process.

Consequently, worry persists as it is the main coping strategy used by GAD patients.

Furthermore, as worry is appraised as uncontrollable, the person makes no or minimal attempts

to suspend worry. Failure to disengage the process results in a lack of opportunity to modify

dysfunctional knowledge about the uncontrollable nature of worry. The metacognitive model

also specifies a maintenance role for a range of behaviors and thought control strategies. For

example, the person with generalized anxiety disorder (GAD) is concerned about the

consequences of worrying and will therefore use avoidance to try to limit worry.

Specifically, attempts are made to avoid triggers for worry episodes, but this denies opportunities

to acquire knowledge that worry is both controllable and not dangerous. The model also specifies

that metacognitive control strategies, such as suppression or mental distraction are frequently

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employed. Unfortunately, these strategies are only occasionally effective, thereby fueling

negative metacognitive beliefs about the danger and uncontrollability of worry.

The metacognitive model of pathological worry and Generalized Anxiety Disorder (GAD)

makes a crucial distinction between two types of worry and explains the persistence and

uncontrollability of negative thinking as an effect of specific metacognitions. The negative

appraisal of worry (meta-worry) and negative beliefs about worry are central to the development

of generalized anxiety disorder (GAD). Furthermore, generalized anxiety disorder (GAD) is

associated with paradoxes in mental control such as the use of extended thinking to reduce

thinking.

1.9.3 Intolerance of Uncertainty Theory

The Intolerance of uncertainty (IU) has been defined as an underlying fear of the unknown. This

model proposes that intolerance of uncertainty (IU), is defined as a dispositional characteristic

encompassing a set of maladaptive beliefs about uncertain situations and events, is pivotal in the

development of generalized anxiety disorder (GAD) by biasing information processing.

The intolerance of uncertainty model has three main components

1. negative problem orientation,

2. positive beliefs about worry and

3. cognitive avoidance.

Intolerance of uncertainty theory is linked to worry through direct and indirect pathways. This

model proposes that intolerance of uncertainty theory directly leads to worry by enhancing

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cognitive biases, whereas the other three components (positive beliefs about worry, negative

problem orientation, and cognitive avoidance) indirectly promote pathological worry.

A particular constellation of core beliefs about uncertainty characterize intolerance of uncertainty

theory, examples include,” uncertainty makes life intolerable; uncertainty makes me anxious, and

uncertainty stops me from functioning.” An individual holding these beliefs perceives

improbable and probable negative events as unacceptable, which in turn accounts for the clinical

presentation observed in generalized anxiety disorder (GAD) patients.

As it is impossible to avoid uncertainty in life, it logically follows that for people who are

intolerant of uncertainty, many situations, events and thoughts will trigger worry.

The other three components of the Intolerance of uncertainty theory model are held to contribute

through indirect pathways. Positive beliefs about worry can be maintained by positive

reinforcement. For example, worry provides a solution to an uncertain situation or negative

reinforcement, or when a feared event does not materialize and there is a reduction in anxiety as

evident in the cognitive avoidance model.

Together, Intolerance of uncertainty theory and positive beliefs about worry lead to chronic

worry, which in turn result in negative problem orientation and cognitive avoidance. Negative

problem orientation essentially refers to a lack of problem solving confidence, which translates

into limited efforts at attempting to deal with difficult situations and perpetuation of false beliefs

about problem solving abilities.

In this model, when you worry, you are trying to reduce feelings of uncertainty. If you worry that

you might be late for an appointment, you will leave much earlier than necessary to be absolutely

certain you get there on time.

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Since it is the uncertainty of events, and not some aspect of them in particular that triggers your

worry, what you worry about through the day will change. In the morning, you might be worried

about making it to a dentist appointment on time, while by evening you could be fretting about

making a decision over which cell phone plan to choose.

In this way, worry is a tactic you use to try and mentally plan and prepare for any possible

outcome, especially bad ones. However, the worry in generalized anxiety disorder can be so

severe that it becomes a problem itself.

1.9.4 Emotional Dysregulation Model

This model posits that a triggering event, in conjunction with an existing diathesis, leads to

negative or positive affect, depending on the person's affective style. Mood and anxiety disorders

are the result of emotion dysregulation of negative affect, coupled with deficiencies in positive

affect.

Emotional dysregulation model of generalized anxiety disorder (GAD) accepts the idea that

worry can function as an avoidant response to distressing emotions. But it is not clear why

emotional states are perceived as so aversive by people with generalized anxiety disorder (GAD).

The emotional dysregulation model proposes that generalized anxiety disorder (GAD) patients

find emotions aversive because of a range of deficits in emotional regulation. Broadly, emotional

regulation is concerned with the adaptive function of emotion and how an individual manages,

expresses and responds to emotion. The emotional dysregulation model proposes that people

with generalized anxiety disorder (GAD) could be conceptualized on the basis of four inter

related deficits in emotional functioning.

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Generalize anxiety disorder (GAD) patients experience emotions more intensely, have a limited

understanding of their emotional experiences which includes difficulty in identifying, labelling,

and describing emotions. This refers to primary emotions, including sadness, anxiety, and

happiness. It may be that generalized anxiety disorder patients experience emotions as

bewildering and undifferentiated events.

The third component has been termed negative cognitive reactivity to emotions which refers to a

set of belief about the negative consequences of experiencing any emotions, as well as greater

difficulty in simply experiencing the emotion without trying to control it. The final component is

unhelpful management of emotions, in which the generalized anxiety disorder patient does not

know how to modulate their strong emotional responses or uses counterproductive strategies.

1.10 EMPIRICAL REVIEW

Worry, especially in a verbal mode, has been shown to cause a temporary restriction in working

memory. A study examined the effects of verbal and image-based worry on working memory,

whether the effect of worry on working memory accounts for interpretation bias in persons with

generalized anxiety disorder, and the degree to which working memory correlates with cognitive

and emotional processes associated with generalized anxiety disorder.

At baseline, participants (N = 32) with generalized anxiety disorder completed questionnaires

assessing worry, and related processes, and working memory and interpretation bias tasks.

Participants were then trained to worry in verbal or imagery form, and completed working

memory and interpretation bias tasks a second time. At baseline, in the absence of induced

worry, lower working memory was related to greater emotion dysregulation, intolerance of

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uncertainty, negative problem orientation, and lower attentional control. Induced worry,

regardless of the form, did not significantly affect working memory or interpretation bias.

In agreement with this context, the present issue of the Brazilian Journal of Psychiatry publishes

a systematic review of brain imaging studies in patients with generalized anxiety disorder

(GAD). This review provides some inspiring data, despite the methodological heterogeneity of

the included studies. Noting that results could be influenced by differences in study design,

variation in image acquisition and processing, and the presence of comorbidities, the authors

nevertheless present consistent data of an association of decreased connectivity between

prefrontal, limbic, and cingulate areas with core symptoms of GAD, such as worry severity.

Moreover, they report altered connection between the amygdala and default mode and salience

networks associated with cognitive and emotional processes in GAD. Some studies also

evaluated neurological functions during the activation paradigm before and after GAD treatment,

and reported that higher baseline reactivity to fearful faces in the rostral anterior cingulate cortex,

as well as dorsolateral and ventrolateral prefrontal cortex reactivity, were associated with better

treatment response. These findings suggest that neuroimaging might be used as a predictor of

treatment response in the future.

Investigators at the Center for Psychotherapy Research conducted a study of state-of-the-art

cognitive behavioral therapy in combination with medication in the treatment of GAD. In this

study, some of the patients receiving medication treatment for their Generalized Anxiety

Disorder were also offered the option of adding cognitive behavioral therapy (CBT) to their

medication treatment. Karl Rickels, MD was the Principal Investigator of this study funded by

the National Institute of Mental Health (NIMH).

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The "Combined Treatment for Generalized Anxiety Disorder" study was a preliminary

randomized clinical trial evaluating the efficacy of combined medication and psychotherapy for

Generalized Anxiety Disorder (GAD). The current study assessed efficacy of combined

cognitive behavioral therapy (CBT) and venlafaxine XR compared to venlafaxine XR alone in

the treatment of generalized anxiety disorder (GAD) within settings where medication is

typically offered as the treatment for this disorder. Patients with DSM-IV–diagnosed GAD who

were recently enrolled in a long-term venlafaxine XR study were randomly offered (n=77) or not

offered (n=40) the option of adding 12 sessions of CBT. The outcome of those offered CBT,

33% (n=26) accepted and attended at least one treatment session.

The outcome results indicated no differences between the combined treatment group and the

medication only group on primary or secondary efficacy measures in any of the sample

comparisons. Many patients who present in medical or psychopharmacology settings seeking

treatment for generalized anxiety disorder (GAD) decline the opportunity to receive adjunctive

treatment. Of those that receive CBT, there appears to be no additional benefit of combined

treatment compared to venlafaxine XR alone.

Normal stress, or eustress, is part of everyone’s daily life. Richard Lazarus (1966) first used the

term eustress to describe the healthy reaction to stress that leads to a positive behavioral response

and feelings of success. Lazarus (1966) believed that people had to perceive a situation as

anxiety provoking in order to trigger this stress response the thoughts that an individual associate

with an event determine if it is perceived as threatening and if a positive outcome is viewed

achievable.

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Saravanan and Wilks (2014) studied the prevalence of depression and anxiety among medical

students of a private Malaysian University. Using the Student Life Stress Inventory and the

Depression Anxiety and Stress scale they found that from a total of 358 students, 44 per cent (i.e.

158 students) were anxious and 34.9 percent (i.e. 125 students) were depressed. Further, females

compared to males were found to be more anxious and stress among students was found to be a

predictor of depression and anxiety.

In another study conducted on the Malaysian Subcontinent, Teh et al (2015) assessed the

prevalence of depression, stress and anxiety among the undergraduate students of Melaka

Manipal Medical

College. Utilizing the Depression Anxiety and Stress scale, they found that from a total of

397undergraduates, 55.5 percent suffered from anxiety, followed by 30.7 from depression and

16.6 percent ranging from a moderate to severe level. Studies with regards to students have

specifically assessed the impact of test anxiety experienced by students on their academic

performance.

Balogun and Onyencho (2017) conducted a research on 393 students in Nigeria, Africa to

determine the moderating role of achievement motivation between test anxiety and academic

performance. The results suggested test anxiety to have a negative impact on academic

performance and achievement motivation to have a positive impact.

In an alarming news article by Brown (2016), it was reported that the American College Health

Association (2015) found one in six college students to be diagnosed or treated with anxiety. Of

the students identified, approximately 21 per cent reported anxiety to have affected their

36
academic performance, in the form of lower grade on an exam or project, doing an incomplete

work or drop out from the course.

With respect to South East Asia, Josephine et al (2006) stated in a research whereby a web-based

survey assessing depression, stress and anxiety was distributed in first year tertiary students of

education in Hong Kong. The results showed that of the 7915 respondents, 41% were found to

have anxiety ranging from moderate to severe.

As indicated, most of the studies in the Malaysian subcontinent have looked at stress, depression

and anxiety as collective variables wherein it’s difficult to delineate the factors contributing

individually to each of them. Depression has been significantly associated with anxiety disorders

as found by many studies (Kessler et al, 2005, 2010; Alono & Lepine, 2007). The current

research aims at understanding the relationship between anxiety and academic performance

among undergraduate students.

A 2015 study Trusted Source found that anxiety disorders are among the most prevalent mental

health conditions in the United States and Europe. According to the Anxiety and Depression

Association of America, 18.1% of the U.S. population reports living with an anxiety disorder

each year.

According to the World Health Organization’s (WHO) most recent estimates in (2015) round the

world, 3.6% of the entire population lives with an anxiety disorder.

1.11 RESEARCH QUESTION

As a fall out of the above, this study wants to research the following questions;

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1. What is the prevalence of generalized anxiety disorder among distance learning institute

(DLI) students of university of Lagos?

2. Will male student of the distance learning institute (DLI) score high on generalized anxiety

disorder scale than the female students?

3. Will there be a significant difference between the level of education on the score of

generalized anxiety disorder among distance learning institute (DLI) students of university of

Lagos?

4. Will there be a significant difference between marital status on the score of generalized

anxiety disorder among distance learning institute (DLI) students of university of Lagos?

5. Will there be a significant difference between age on the score of generalized anxiety

disorder among distance learning institute (DLI) students of university of Lagos?

1.12 RESEARCH HYPOTHESIS

1. There would be a high prevalence of generalized anxiety disorder among distance learning

institute (DLI) student of the university of Lagos.

2. Male student of the distance learning institute (DLI) would score significantly high on

generalized anxiety disorder scale than the female students.

3. There will be a significant difference between the level of education on the score of

generalized anxiety disorder among distance learning institute (DLI) students of university

of Lagos.

4. There will be a significant difference between marital status on the score of generalized

anxiety disorder among distance learning institute (DLI) students of university of Lagos.

38
5. There will be a significant difference between age on the score of generalized anxiety

disorder among distance learning institute (DLI) students of university of Lagos.

39