2 Anxiety disorders: Generalised Anxiety Disorders Flashcards
What were the changes to anxiety disorders from DSM to DSM-5?
PTSD and acute stress disorder being moved to trauma and stressor-related disorders
Obsessive-compulsive disorder was moved to obsessive-compulsive and related disorders
What are the DSM-5 Anxiety Disorders?
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Anxiety Disorder (Social Phobia)
- Panic Disorder
- Agoraphobia
- Generalized Anxiety Disorder
Define Generalised Anxiety Disorder (GAD) according to DSM?
Tendency to worry excessively and uncontrollably about a variety of events and outcomes. The worrying is not irrational but is disproportionate to the situation.
What is the DSM criteria for GAD?
- Occurs more days than not for 6 months
- Not explained by a normal situation
- Requires at least 3/6 of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance -> does not include autonomic arousal
Also: Need to distinguish from other disorders that also involve excessive worry
What is classified as normal worry?
Occurs in response to perceived future which is usually physical (in older adults) or social (in young adults). it tends to be compromised of more verbal thoughts rather than imagery. This type of worry has positive aspects such as motivation, problem-solving, avoiding negative outcomes, distraction. Attempts to control worry usually involve problem-solving, distraction or social support
What are the perceived positive aspects of normal worry?
Egosyntonic (acceptable to the self), has positive aspects by motivating action, helps to problem solve, avoid negative outcomes, distract from more distressing topics (Dugas et al, 1998, Freeston et al, 1994)
What are the perceived negative aspects of normal worry?
Egodystonic (unacceptable to the self)
What is Davey, 1994’s theory of causation in GAD?
Problem-solving theory
- Worry involves problem-solving events. In pathological worrying, this process is thwarted
- Biased threat perception triggers more worries; (every time you see a problem, you something that may be wrong with it and more evidence is needed if a solution is to be accepted)
- Social problem solving (D’Zurilla & Maydeu-Olivares, 1995)
What is Borkovec, 1994’s theory of causation in GAD?
Avoidance Theory
- Worrying contains more verbal thought than imagery. GAD patients are more inclined to worry using imagery.
- Images of possible negative events are highly aversive -> cause anxiety symptoms
- Reduced imagery -> reduced arousal/anxiety
List what is involved in social problem solving (D’Zurilla & Maydeu-Olivares, 1995).
- Problem definition
- Generation of alternative solutions
- Solution evaluation (positive/negative)
- Solution Selection
Why is it in GAD you don’t experience autonomic arousal?
It is said in GAD you don’t experience the autonomic arousal since the function of the words takes away the distressing imagery that brings upon the anxiety symptoms
What role does worrying play in avoidance theories?
Worry is a form of cognitive avoidance, it interferes with emotional processing and maintains fear structures
What is the experiential avoidance in theories of causation?
Perhaps excessive worry is associated with fear of anxiety and the intolerance of distress and experiental avoidance
What is the experiential avoidance in theories of causation?
Perhaps excessive worry is associated with fear of anxiety and the intolerance of distress and experiential avoidance
Worriers avoid internal experiences
Attempts to predict negative/uncomfortable effect - difficulties in clearly identifying, tolerating and modulating emotion
In experiential avoidance what does it mean by fear of anxiety (Buhr & Dugas, 2009)?
Very sensitive to anxiety; worry more
In experiential avoidance what does it mean by distress intolerance (Huang, Szabo & Han, 2010)?
People with lower tolerance worry more
What is meant by experiential avoidance?
Worriers avoid internal experiences and/or alter internal experiences
What is Ladouceur et al., 2000’s theory of causation in GAD?
Intolerance of uncertainty
- Uncertainty reflects badly on a person, causes frustration and stress, and prevents action
- Worry is used to reduce anxiety with the aim to reduce uncertainty to zero (however, we can never be 100% certain). This leads to a preoccupation with details and interferes with problem-solving
What is the meta cognitive theory in theories of causation (Wells, 1995, Wells & Carter, 2001)?
Suggests there are two types of worry; worry and metaworry
Worry - normal threat perception + positive beliefs about worry -> worry to cope with the threat and problem solve (possible exit)
Metaworry - worry + negative beliefs about worry -> metaworry -> ineffective thought control strategies -> increased anxiety and worry until it is excessive and uncontrollable
Give an example of a situation in metacognitive theory
You perceive a threat and you believe worrying is going to be helpful in that situation and have that possible exit (positive worry) -> Have that rationale for worrying and you’ve worried and that might resolve it for you
It doesn’t stop there for people who experience pathological worry you can’t exit there and you keep on going which leads to type 2 meta worry
List some assessments use to measure GAD
- Anxiety disorders interview schedula (ADIS)
- Depression anxiety stress scales (DASS)
- Model-specific questionnaires
- Worry questionnaires e.g. PSWQ and WAQ
- Gad-specific questionnaires
How does one treat metacognitive worry?
Challenge beliefs about worry (positive and negative)
-Attention training detached mindfulness (Metacognitive)
How should one treat biased threat perception?
Cognitive challenging: examine the probability and cost judgments
How should one treat avoidance?
Exposure to vivid images of the feared event
Exposure to anxiety/emotional experience/distress Exposure to uncertainty (avoidance)
How should one treat problem-solving?
Structured problem solving training
How well do treatments work?
Treatments effects have been modest at best, one of the hardest disorders to treat and about 50-60% improvement at follow-up
