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PROPOSAL TEST ANXIETY LEVEL BASED ON GENDER AMONG SEMESTER V MEDICAL STUDENTS OF UDAYANA UNIVERSITY BALI INDONESIA. YOGESWARY PHNNIR SALVAM 1202005227 MEDICAL EDUCATION STUDY PROGRAM FACULTY OF MEDICINE UNIVERSITY UDAYANA DENPASAR 2015

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  • PROPOSAL

    TEST ANXIETY LEVEL BASED ON GENDER AMONG SEMESTER V MEDICAL STUDENTS OF

    UDAYANA UNIVERSITY BALI INDONESIA.

    YOGESWARY PHNNIR SALVAM

    1202005227

    MEDICAL EDUCATION STUDY PROGRAM

    FACULTY OF MEDICINE

    UNIVERSITY UDAYANA

    DENPASAR 2015

  • ACKNOWLEDGEMENT

    I take this opportunity to express my profound gratitude and deep regard to my

    guide dr. I Wayan Westa, Sp.KJ (K) for his exemplary guidance, monitoring and

    constant encouragement throughout the course of this research. The blessing, help

    and guidance given by him time to time shall carry me a long way in the journey

    of life on which I am about to embark. Then I also would like to thank my friends

    for motivating me and appreciating my work. I would also like to thank my

    parents for helping me and encouraging me to go my own way. I wish to

    acknowledge the contribution and the support of the Udayana University and to

    the medical students for their participation in this elective study. Last, but not the

    least, I would like to thank God, who made all the things possible and made it

    successfully.

  • CONTENT

    ACKNOWLEDGEMENT...i CONTENT...........ii CHAPTER I: INTRODUCTION

    1.1 Research Background....................1 1.2. Problem Identifications........3 1.3. Aim of Research.......3 1.4. Research Benefits.........3

    CHAPTER II: LITERATURE REVIEW 2.1.Definition......4

    2.2. Factors..5 2.2.1 Gender............5 2.2.2 Life style issues..........6 2.2.3 Lack of information...........6 2.2.4 Psychological factor...............6 2.2.5 Biological Factor............................6 2.3. Diagnosis..........................................................................................7 2.3.1. GAD-7......7 2.3.2. HAM-A/HARS.....7 2.3.3. TAQ..........7 2.4. Treatment.........................................................................................8 2.4.1. Medication............8 2.4.2. Cognitive Behavioral Therapy......8 2.4.3. Meditation.........9 2.4.4. Parental Anxiety Management......9 2.4.5. Combined Treatments ..........9 2.4.6. Elimination of Caffeine .......9 2.4.7. Other Treatments......10

    CHAPTER III: CONCEPT, OPERATIONAL DEFINITION, HYPOTHESIS 3.1 Concept11 3.2 Operational Definition 3.2.1. Anxiety ........................12 3.3 Hypothesis........................................................................................12

    CHAPTER IV: METHOD OF RESEARCH 4.1. Design of Research.13 4.2 Population and Sample of Research 4.2.1. Population of Research....13 4.2.2. Criteria of Sample....13 4.2.3. Sample Size..14 4.2.4. Method of Sampling for Research...14 4.3 Research Variable....14 4.4. Data Collecting Method and Analysis....14 4.5 Place and Time of Research.....15 4.6 Instrument of Research....15 4.7 Limitation of Research.........15

    REFERENCE.............................................................................................16

  • i

    CHAPTER I

    INTRODUCTION

    1.1 Research Background

    Medical conditions such as depression, insomnia, stress, bipolar disorders and

    post-traumatic disorders and moreover anxiety has increased in number of cases

    rapidly over the past years especially among students due to pressure they gone

    through in their daily life and also to perform well.

    As we know today, anxiety is became a common phenomenon of everydays life. It plays an important role in human life because all of us are the victims of

    anxiety in different ways and in different situation of our daily life activities.

    Generally speaking, anxiety can either be a trait anxiety or a state of anxiety. Trait

    anxiety which means, a stable characteristic or else trait of the person who undergoes

    anxiety. State anxiety is the one which is aroused by some temporary situation of the

    environment such as examination, accident, punishments and others (Mohammad

    Nadeem et al, 2012). We all sure would have experienced at least a minor anxiety at

    some point in our lives. Actually, it is the feeling of thousand butterflies flying in

    your stomach before like a big date with someone, the tense feeling you get when

    yourself know that you're in danger (eg: dog chasing you). Globally, approximately

    273 million (4.5% of the general population) who had an anxiety disorder. It is more

    common in females (5.2%) than males (2.8%).In Asian countries, the lifetime rates of

    anxiety disorders are probably between 9% and 16%, and while the yearly rates are

    between 4% and 7% (Prof Theo Vos et al, 2010).

  • ii

    Nowadays, test anxiety is a common or maybe main cause of poor academic

    performance among students in every part of this world. The work of assessing

    students learning is complex. In order to assess to their work objectively, teachers and instructors use various methods and instruments, one of which is examination.

    We are aware that nowadays examination has become an inherent part of the society

    we live in. Consequently, most of the important decisions are made mainly based on

    exam results. So, it is not surprising if test anxiety during examination period has

    become a most prominent problem in school and also universities.

    Therefore, test anxiety can also interfaces with learnings in that more anxious students will be more easily distracted by irrelevant aspects of the task at hand and

    also having trouble in focusing on significant details or information. In addition, it is

    also more common in females than in males. Having an anxiety disorder means

    coping with everyday life while feeling anxious and worried, with sweaty palms and

    a pounding heart, with a paranoid sense that something bad is going to happen, or

    even with the threat of a looming panic attack. This is what millions of females deal

    with daily, but why they are more likely than males to experience anxiety is still a

    mystery. It clearly shows that gender as associated factors that lead to different test

    anxiety level among students.

    Therefore, it is concluded that test anxiety level based on gender too (Shireen

    et al, 2008). This problem should be overcome immediately as it can cause a variety

    of effects such as it can cause the affected student to be unable to concentrate on their

    education, it can also cause them to constantly lose focus and not actually perform

    well during their examination which then leads them to fall into depression state.

  • iii

    Based on this research background, the topic Of Test Anxiety Level Based on Gender

    as Associated Factor among Semester V Medical Students of Udayana University

    Bali, Indonesia was chosen.

    1.2 Problem Identifications

    a. How many of the semester V female and male medical students of Udayana

    University are affected with mild test anxiety level?

    b. How many of the semester V female and male medical students of Udayana

    University are affected with moderate test anxiety level?

    c. How many of the semester V female and male medical students of Udayana

    University are affected with severe test anxiety level?

    d. Does gender as associated factor contribute to test anxiety level among

    semester V medical students of Udayana University?

    1.3 Aim of Research

    Mainly this research is to investigate the test anxiety level based on gender

    among semester V English class medical students of Udayana University.

    1.4 Research Benefits

    a. The result of this study may also provide information and latest updates to

    teachers and students about the test anxiety level based on gender among

    semester V medical students of Udayana University.

    b. It may help teachers to guide and motivate students according to their

    requirements and background.

    c. Knowing the test anxiety level of semester V medical students of Udayana

    University according to their gender who are suffering from test anxiety.

  • iv

    CHAPTER II

    LITERATURE REVIEW

    2.1 Definition

    Anxiety has been defined as a diffuse, unpleasant, vague sense of

    apprehension, which is often assisting by autonomic symptoms, likewise headache,

    perspiration, palpitations, stiffness in the chest, and mild stomach discomfort feeling

    (Kaplan, H. and Sadock, 1996). Benjamin (1987) noted that test anxiety can interface

    with attention, learning and testing. The idea that test anxiety may interface with a

    student's ability to demonstrate completely what they have learned is not new. In

    1998 test anxiety also defined by Zeidner, that its a set of phenomenological, physiological, and behavioral responses that accompany concern about possible

    consequences or else failure on an exam or similar evaluative situation or condition

    (Dr.Sadhan Das Gupta et al,2012). In contrast to fear, anxiety involves a more general

    or diffused emotional reaction to beyond simple fear which that is out of proportion

    to threats from the environment. Freud called anxiety as emotional pain. Anxiety

    interferes with school functioning only when an abnormal level is reached, where as

    within normal range, being anxious does not automatically imply worst school

    functioning and indeed may to a certain extent be motivating and enhancing to

    academic performance and this known as test anxiety. Test anxiety defined as

    perceived arousal, reported worry, self-denigrating thoughts, tension, and reports of

    somatic symptoms in exams or similar evaluative situations. For individuals with test

    anxiety, both preparing for and taking a test cause high level of worry and discomfort.

  • v

    As a result, affected students do not perform to their potential and their test scores

    misrepresent their level of knowledge and understanding. In addition, it was found

    that boys regard a examining situation as a challenge for them in their academic life

    and therefore as low test anxious has determined while in contrast with girls that tend

    to see the testing or evaluative situation as a threat or danger that they have to

    undergoes, and therefore they are tend to be more test anxious compared to males. So

    that as the consequences of this problem some studies was conducted to investigate

    effect of gender on test anxiety level (Zaheri et al, 2012).

    2.2 Factors

    The main contributing factors of test anxiety are such gender, age, life style

    issues, lack of required information and studying style, psychological factors and

    biological factors (Shireen Hashmat et al, 2008).

    2.2.1 Gender

    According to Zeinder (1977), the main interpretation of these revealed gender

    difference is that males and females socialized to experience evaluation situations

    differently and also respond to test anxiety in different ways. It has been suggested

    that males may be more likely to perceive examination situations as a personal

    challenge rather than as a threat and exhibit behavior characteristic of highly anxious

    individuals like fear, feeling worry, anger, lower self-esteem (Zaheri et al, 2012).

    Males and females show a clear difference in the levels of anxiety they experience.

    Females greater anxiety appears to place them at a disadvantage (Ellen Rydell Altermatt et al, 2004).

  • vi

    2.2.2 Life style issues

    Life styles related issues include inadequate rest, insufficient physical activity,

    poor nutrition and lack of time management are found to be the contributing factors

    leading to exam anxiety as reported by many authors (J.A. Afolayan et al, 2013).

    2.2.3 Lack of information

    Sujit et al have reported that lack of strategic studying likewise ineffective

    studying style through inconsistent content coverage and also most of the students

    will studying all night before exams which causes them to be inadequate rest,

    inefficient studying style too which includes lack of revising and review of course

    material studied are major factors leading to differ in test anxiety level (J. A.Afolayan

    et al, 2013).

    2.2.4 Psychological factors

    Psychological factors which contribute significantly to exam anxiety are

    negative and irrational thinking about exams, outcomes of exams and feelings of no

    control over exam situation (e.g. going blank during exam) are reported by many

    authors (shireen Hasmat et al, 2008).

    2.2.5 Biological factors

    It is basically a series of biochemical changes in human brain and body, such

    as increase in adrenaline (causing heart to beat faster) and a decrease in dopamine (a

    brain chemical that helps to block pain). These changes result in a state of heightened

    attention to the source of the anxiety. A high level of anxiety causes human body to

    prepare to fight or run away from the perceived threat which commonly called as

    flight-or-fight response (shireen Hasmat et al, 2008).

  • vii

    2.3 Diagnosis

    There are several steps that need to be done to confirm the diagnosis.

    Diagnosis of anxiety disorder can be made by taking complete anamnesis and by the

    usage of screening tools that is valid to be use among that particular country

    population. The anamnesis can be done by using basic four and sacred seven concept.

    From the anamnesis, actually we can have a rough idea on what the supposed

    diagnosis will be for that case and also by asking specific question and information

    that required which will further support our suspected diagnosis to be confirmed.

    Screening tool that can be use is as follows:

    2.3.1 GAD-7 (Generalized Anxiety Disorder- Seven Item Scale)

    The GAD-7 is a 7 item scale, which is useful for screening Generalized

    Anxiety Disorders severity level in clinical practice and also in research study. This GAD-7 can also be used to assess the therapeutic interventions, so which help us to

    know the progress of that patient (Spitzer RL et al, 2006).

    2.3.2 HAM-A/HARS (Hamilton Rating Scale for Anxiety)

    Hamilton Anxiety Rating Scale is a 14 item scale, which designed to identify

    the level of anxiety symptoms and also to assess the response to therapeutic

    interventions that have already done to the patient (Hamilton M. et al, 1959).

    2.3.3 TAQ (Test Anxiety Questionnaire)

    Nist and Diehl (1990) developed a short questionnaire for determining if a

    student experiences a mild or severe case of test anxiety. It indicates how often each

    statement describes who fill-up the questionnaire by choosing a number from one to

    five as outlined 1- never, 2 - rarely, 3 - sometimes, 4 - often and 5 - always.

  • viii

    2.4 Treatment

    Treatment for anxiety is not specified yet and it depends on the severity level.

    Medication will not cure anxiety disorders but will keep them under control. Taking

    prescription of drugs does not really cure the underlying causes of the anxiety

    problems that faced by the person. Drug treatments for anxiety disorders work by

    downplaying threat detecting mechanisms in the body (Terry Dixon, 2011).

    2.4.1 Medication

    The first famous known medication is benzodiazepines such as Alprazolam,

    Diazepam, and Lorazepam commonly used to treat test anxiety with low dosage

    while at higher dosage it can lead to sedative effect. Antidepressant commonly used

    for general depression, which can accompany test anxiety. Side effects include, but

    are not limited to, the potential to cause agitation and suicidal thoughts. These need to

    be taken on a regular basis not when needed before an exam (Terry Dixon, 2011).

    2.4.2 Cognitive behavioral therapy

    Cognitive Behavioral Therapy (CBT) is very useful in treating anxiety

    disorders. CBT helps to change the pattern of thinking that support the fear and help

    the sufferer overcome the negative beliefs. CBT often lasts about two weeks and

    takes place in small groups. Medication combined with psychotherapy has shown to

    be the most effective treatment approach for people suffering from anxiety disorders.

    Cognitive interventions have only had limited results when it comes to improving test

    performance (Olatunji et al, 2010).

  • ix

    2.4.3 Meditation

    Meditation, is one kind of treatment that use to treat test anxiety (Jon Kabat-

    Zinn et al, 1992). Meditation reduces anxiety level mentally. Most commonly other

    simple activities likewise jogging, lying down for a moment, walking around or just

    listening to the simple, soothing and also mind relaxing music which will help to

    decrease the test anxiety level in particular individual.

    2.4.4 Parental Anxiety Management

    Recent years have seen increasing interest in the role the family plays in the

    development and treatment of childhood disorders. (Paula M. Barrett et al, 2001).

    Although it is always advisable to seek professional help, especially in more severe

    cases, help is not always readily available. Even if parents do decide to seek help in

    managing their child's anxiety, they can still play a key role in helping their child.

    2.4.5 Combined treatments

    Some research also shows that a combination of CBT and Parental Anxiety

    Management has been proven to be more effective than administering these

    treatments separately (Paula M. Barrett et al, 2001).

    2.4.6 Elimination of Caffeine

    Stimulants are some type of chemicals that excite your central or peripheral

    nervous system in your body system. The term "excite" in this matter, means which

    release more chemicals or send more and faster messages through your nervous and

    body system to the brain. While each of these excites our mind and body, and also

    can create extra energy that is transformed into anxiety or else create nervous or tense

    feeling toward the situations. Caffeine known to be the most common stimulant that

  • x

    often found in coffee (P.Narrow et al, 2003). Especially, one cup of coffee in the

    morning is most unlikely to cause extreme anxiety although different people can react

    differently towards the stimulant, so it may contribute to more anxiety symptoms (A.

    Smith, 2002).

    2.4.7 Other treatments

    Other treatment methods that could use in treating severe anxiety cases also

    include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS),

    psychosurgery, and also breathing training teaches correct breathing habits to people

    with anxiety disorders (Nicola Reavley et al, 2010).

  • xi

    CHAPTER III

    CONCEPT, OPERATIONAL DEFINITION AND HYPOTHESIS

    3.1 Concept

    Based on the description mentioned above, hence the main concept of this

    study is to know the test anxiety level based on gender as associated factor.

    Semester V English class medical students of both gender of Udayana University

    Test

    Test Anxiety

    Moderate Anxiety

    Severe Anxiety

    No Anxiety

  • xii

    3.2 Operational Definition

    3.2.1 Anxiety

    To evaluate test anxiety level, Test Anxiety Questionnaire (TAQ) is used.

    Nist and Diehl (1990) developed a short questionnaire for determining if a student

    experiences a mild or severe case of test anxiety level. Score ranged from 10 to 50.

    a. 10-19: no test anxiety

    b. 20-35: moderate test anxiety

    c. 35-50: severe anxiety

    3.3 Hypothesis

    Since it is a descriptive study, this study does not have a hypothesis. However

    a predictable hypothesis would be those female students will have more test anxiety

    level than male students.

  • xiii

    CHAPTER IV

    METHOD OF RESEARCH

    4.1 Design of Research

    This research which investigates the problem of test anxiety level is known as

    descriptive study. Descriptive study is the study that uses the collection of data

    without any manipulation of the surrounding environment with true data. This study

    is a one-time interaction study which is with the groups of people or else clearly

    known as the cross sectional study. As this study was descriptive at first, we shall use

    survey technique, questionnaire and checklist by given it to the participants by the

    researcher or investigator. Therefore, descriptive studies such as a cross-sectional

    study, really helps in generating the hypothesis on which further research may be

    carry out.

    4.2 Population and Sample of Research

    4.2.1 Population of Research

    Target population of this study is the English class students of Udayana

    University in Denpasar, Bali. These students will particularly be chosen from English

    class students who are currently pursuing their studies in semester V.

    4.2.2 Criteria of Sample

    Research will take place on campus students and these students selection

    randomly done based on the name list of semester V students from the faculty of

    medicine of Udayana University. Moreover, in this descriptive study about 100

    students in total will be selected which includes 50 males and 50 females. All the

  • xiv

    participants will be assured that confidentiality of information provided and moreover

    they will be approached and each of them will be provided an informed consent

    particularly before each of them participating in this research study. The inclusion

    criterias for this study are the participants selected must be aged between 19 to 22 years old, from both genders, stable mental status, and joins the study research

    willingly.

    4.2.3 Sample Size

    The sample size of this research is that, 100 medical students of semester V of

    English class from medical faculty of Udayana University which is composed of 50

    males and 50 females.

    4.2.4 Method of Sampling for Research

    Sampling technique that will be used for this research study is simple random

    sampling. The investigator selects 100 medical students of Udayana University from

    a name list of semester V English class students. Each name will be put on a separate

    small piece of a sheet and then the names will be drawn randomly until all the 100

    names have been picked up and it will be recorded accordingly.

    4.3 Research Variable

    In this descriptive study, to investigate the above stated problem, medical

    university students of Udayana University will be approached. They will be given

    papers of questionnaires to access their test anxiety level.

    4.4 Data Collecting Method and Analysis

    The data will be collected from students who are studying in the faculty of

    medicine Udayana University specifically those who are in their fifth semester of

  • xv

    English class students. Ethical approval was obtained from the respective relevant

    ethics committee within the Udayana University.

    4.5 Place and Time of Research

    This research will be conducted at University of Udayana Denpasar, Bali. The

    time and duration of data collection is from 10 am in the morning until 4pm in the

    evening. The questionnaire paper will fill-up own by the English class students

    exactly one week before their exam. The questionnaire used for the study was

    designed by the researchers and self administered to the students and collected at the

    spot after been fully completed by the students.

    4.6 Instrument of Research

    The instrument that used in this investigation is questionnaire to access test

    anxiety level. The questionnaire consisted of two sections. Section A was designed to

    collect data on personal variables of gender, age and religion. While the other one

    Section B will be focus on the study objective or aim of this research. The

    questionnaire had particular items on indicators of variables to require the opinion of

    respondents or participants. The questionnaire used in this research Test Anxiety

    Questionnaire (TAQ).

    4.7 Limitations of Research

    This descriptive cross sectional study uses questionnaire to analyze, hence it

    may not be entirely true since it depends on the person or participants who willingly

    join the study on what they would like to fill up in their forms. Sometimes they also

    may refuse to provide the accurate answers in the questionnaire given due to some

    personal thoughts.

  • xvi

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    As we know today, anxiety is became a common phenomenon of everydays life. It plays an important role in human life because all of us are the victims of anxiety in different ways and in different situation of our daily life activities. Generally spea...2.3 DiagnosisThere are several steps that need to be done to confirm the diagnosis. Diagnosis of anxiety disorder can be made by taking complete anamnesis and by the usage of screening tools that is valid to be use among that particular country population. The ana...Treatment for anxiety is not specified yet and it depends on the severity level. Medication will not cure anxiety disorders but will keep them under control. Taking prescription of drugs does not really cure the underlying causes of the anxiety proble...