3 - Anxiety Disorders: GAD

Question 1

What new chapters were distinguished in the DSM-5?

Answer 1

Obsessive-Compulsive and Related disorders
AND
Trauma and Stressor-Related Disorders

Question 2

What disorders are listed under Anxiety Disorders in DSM-IV?

Answer 2

• Panic Disorder (unexpected/spontaneous panic attacks, anxiety about having attacks, can occur with/without agoraphobia)
• Separation Anxiety Disorder (being away from primary caregiver)
• Specific Phobias
• Social Phobia (main fear is negative social evaluation)
• Generalised Anxiety Disorder (excessive and uncontrollable worry about a range of outcomes)
• OCD (obsessions = intrusive thoughts/impulses, compulsions = ritualised behaviours in response)
• Posttraumatic and Acute Stress Disorders (focus of fear is also focus of avoidance, reinforcing anxiety)

Question 3

What disorders are listed under Anxiety Disorders in DSM-5?

Answer 3

• Separation Anxiety Disorder
• Selective Mutism
• Specific Phobia
• Social Phobia (Social Anxiety Disorder)
• Generalised Anxiety Disorder
• Panic Disorder
• Agoraphobia

Question 4

What is listed under Obsessive Compulsive and Related Disorders chapter in the DSM-5?

Answer 4

• OCD
• Body Dysmorphic Disorder
• Hoarding Disorder
• Trichotillomania (hair pulling)
• Excoriation (skin picking)
  Involve levels of anxiety married with compulsions.

Question 5

What is listed under Trauma- and Stressor-Related Disorders chapter in the DSM-5?

Answer 5

• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder
• PTSD
• Acute Stress Disorder
• Adjustment Disorder

Question 6

What is the DSM-IV/5 definition of Generalised Anxiety Disorder?

Answer 6

• Excessive, uncontrollable worry about a variety of events/outcomes
• Occurs more days than not for at least 6 months.
• At least 3/6 somatic symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance)
• Does not include autonomic arousal (palpitation, hyperventilation, nausea)
• Need to distinguish from other disorders that also involve excessive worry

Question 7

Define Normal Worry.

Answer 7

• Occurs in response to a percieved future threat
• Mainly focused in social threat in adults and physical threat in older adults
• Contains more verbal thought than imagery
• Positive aspects; motivates action, helps problem solving, distract from more distressing topics, avoiding negative outcomes
• Is controlled by problem solving, distraction, social support

Question 8

What are the problem solving theories that explain how GAD develops?

Answer 8

• “normal” worrying involves problem solving attempts

- the problem solving of pathological worriers are “thwarted” through biased threat perception triggering more worries

Question 9

Explain Avoidance Theory.

Answer 9

Borkovec, 1994.
Worry contains relatively more verbal thought than imagery.
- Images of possible negative events are highly aversive.
- cause anxiety symptoms, also aversive.
- Reduced imagery leads to reduced arousal/anxiety
- GAD is associated with tension rather than fear symptoms
- So, worry can be seen as cognitive avoidance.
- cognitive avoidance interferes with emotional processing, and fear structures are maintained.

Question 10

What is Experiential Avoidance?

Answer 10

Worry is associated with;
- fear of anxiety/anxiety sensitivity
- distress intolerance
- experiential avoidance (best way to check for experiences is to think or worry about the future)
- worriers tend to avoid internal experiences
Difficulties in emotion regulation. Worriers have difficulties in:
- clearly identifying emotion
- tolerating emotion
- modulating emotion

Question 11

What is Intolerance of Uncertainty Theory?

Answer 11

Ladouceur, 2000

• Uncertainty reflects badly on a person, causing frustration and stress, preventing action
• worrying reduces uncertainty
• leads to a preoccupation with details
• interferes with problem solving
• worriers aim to reduce uncertainty to zero (as this is not possible, their worry is perpetuated)

Question 12

What is Metacognitive Theory?

Answer 12

There is worry (type 1) and metaworry (type 2)
Type 1 Worry:
- perceotion of threat+ positive beliefs about worry -> worry to cope with threat
- possible exit by problem solving or reassurance
Type 2 Metaworry:
- worry + negative beliefs about worry -> metaworry (too much/little) -> ineffective thought-control strategies -> increased anxiety/worry
- leads to excessive and uncontrollable worry

Question 13

What are treatment options for GAD?

Answer 13

• Biased threat perception (addressing probability and cost judgement)
• Structured problem solving training
• ‘Avoidance’ (exposure to images of feared event, anxiety/emotional experience/distress/uncertainty)
• ‘Metacognitive’ (challenge beliefs about worry (positive and negative)

Question 14

Describe how well GAD is at being treated?

Answer 14

GAD treatments are not as effective as those for other anxiety disorders.
Around 50-60% are diagnosis free after 1 year follow up.