7 Anxiety 3 – GAD

Question 1

When was Generalised Anxiety Disorder (GAD) first introduced into DSM?

Answer 1

Into DSM-III-R (1980)

Question 2

What are the four criteria for GAD?

Answer 2

1. Excessive, uncontrollable worry about a variety of events/outcomes
2. Occurs more days than not
3. For at least 6 months
4. At least 3 of 6 somatic symptoms
   - restlessness
   - fatigue
   - difficulty concentrating
   - irritability
   - muscle tension
   - sleep disturbance

Question 3

What physiological aspect differentiates GAD from other anxiety disorders?

Answer 3

It’s the only anxiety disorder not strongly associated with autonomic arousal.

Question 4

Is GAD just excessive worry?

Answer 4

No, it must also be uncontrollable, as this suggests a different dysfunction. Compare difference between 1) eating lots because you like food and 2) not being able to control eating.

Question 5

What kind of threat perception is typical of older adults/young people?

Answer 5

Older adults generally worry about physical/health threats

Younger adults generally worry about social threat

Question 6

Do people with GAD worry about different things from normal worriers?

Answer 6

No, they just worry more and about more things.

Question 7

What are 4 perceived positive aspects of worrying?

Answer 7

1. Motivates action
2. Helps to problem solve
3. Helps avoid negative outcomes
4. Distracts from more distressing topics (perhaps typical of GAD)

Question 8

In what three ways is worry most commonly managed in normals?

Answer 8

1. Problem-solve the situation
2. Distract yourself
3. Seek social support

Question 9

Can GAD be explained by biased threat perception?

Answer 9

Not entirely. Sure, people with GAD have biased threat perception, but this DOESN’T explain why they worry obsessively rather than having a panic attack or cleaning house, cutting themselves etc.

Question 10

How can GAD be explained through problem-solving theory?

Answer 10

GAD sufferers can’t exit worry via problem solving because each solution solicits new threat perceptions. E.g. ‘Worried about exam, if I study more won’t see friends, they’ll hate me.’

Question 11

What are the 4 stages of D’Zurilla and Maydeu-Olivares (1995) theory of Social Problem Solving?

Answer 11

1. Problem definition
2. Generation of alternative solutions
3. Solution evaluation positive/negative
4. Solution selection

Question 12

Which stages of Social Problem Solving go wrong in GAD?

Answer 12

3. Solution evaluation positive/negative – see new threats in every solution
4. Solution selection –all solutions seem fraught with risk

Question 13

How can it be argued that GAD is dysfunctional?

Answer 13

Main function of worry is to avoid negative consequences. GADders create a negative consequence for themselves.

Question 14

How does Borkovec’s cognitive avoidance theory explain GAD?

Answer 14

People with GAD worry – a verbal mental activity – to avoid visual imagery, which is more arousing and more aversive.

Question 15

Is worrying more verbal or image-based?

Answer 15

Verbal. When people switch from relaxation to worry, verbal centres light up. We tend to worry in words.

Question 16

What is more aversive, according to Berkovec, images of a possible negative event or worry about the event?

Answer 16

Images –they cause more anxiety symptoms than worry, which is largely verbal.

Question 17

How can cognitive avoidance maintain worry, selon Berkovec?

Answer 17

Cognitive avoidance (of imagery) interferes with emotional processing of that imagery. Can’t habituate to image, which reduces fear of it. No reduction of cost.

Question 18

GAD is more associated with __________ tension than with ___________ arousal.

Answer 18

GAD is more associated with muscle tension than with autonomic arousal.

Question 19

Why do some people want to avoid autonomic arousal/anxiety more than others?

Answer 19

Because of individual differences in ability to tolerate autonomic arousal.

Question 20

What kind of sensitivity is GAD associated with?

Answer 20

With anxiety sensitivity –GAD sufferers dislike sensations of anxiety more than normals.

Question 21

Like people with eating disorders, GAD sufferers have high ____________, but instead of binging, say, they worry.

Answer 21

Like people with eating disorders, GAD sufferers have high distress-intolerance, but instead of binging, say, they worry.

Question 22

According to avoidance theory, people with GAD worry because it feels better than feeling ____________.

Answer 22

According to avoidance theory, people with GAD worry because it feels better than feeling anxious.

Question 23

According to Hayes et al. (1996) GAD sufferers avoid not only anxiety, but also?

Answer 23

Any internal experiences. Try to reduce feeling anything – positive or negative. ‘As soon as I feel good, something bad must be about to happen!’

Question 24

GAD sufferers have problems with regulation (identification, tolerance, modulation) of what?

Answer 24

Emotion

Question 25

When they can’t regulate the emotions elicited by a perceived future threat, what do GAD sufferers do?

Answer 25

Worry about it

Question 26

According to Ladouceur et al. (2000) GAD sufferers are intolerant of what?

Answer 26

Uncertainty

Question 27

What beliefs about uncertainty might drive GAD?

Answer 27

• Uncertainty reflects badly on a person
• Uncertainty causes frustration and stress
• Uncertainty prevents action

Question 28

How much uncertainty can GAD sufferers handle?

Answer 28

Zero – they try to reduce it to an unreasonably low limit

Question 29

Intolerance of uncertainty leads to a preoccupation with _________ and interferes with ______________

Answer 29

Intolerance of uncertainty leads to a preoccupation with details and interferes with problem-solving

Question 30

What is Wells’ (1995) disctinction between Type 1 and Type 2 worry?

Answer 30

Type 1 is normal worry –worry about perceived threat

Type 2 is metaworry –worry about worry

Question 31

What is the difference in beliefs about worry between Type 1 and Type 2 worriers?

Answer 31

Type 1 (normal worriers) have positive beliefs about worry –they think it’s useful

Type 2 (metaworriers) have negative beliefs about worry –they think it’s to be avoided

Question 32

What causes metaworry to spiral?

Answer 32

Ineffective thought control strategies –e.g. suppression, self-directed anger –make it difficult to leave worry process, thus amplifying metaworry.

Question 33

What does the diversity of theories about GAD suggest?

Answer 33

That we don’t really know what causes and maintains it.

Question 34

How can GAD be treated by modifying biased threat perception?

Answer 34

Must be a general approach –can’t attack worries one by one. Attack general tendency to overestimate threat.

Question 35

How can GAD be treated by modifying problem-solving strategies?

Answer 35

Through problem-solving training. GAD sufferers need to learn how to come up with positive solution evaluations –not just negatives… ‘buts’

Question 36

How can GAD be treated by reducing avoidance of images of a feared event?

Answer 36

Exposure. If GAD sufferers are worrying to avoid anxiety induced by imagery, then need to do exposure to whatever it is these people are avoiding. If worry about failing the exam, picture what will happen if it does happen?

Question 37

How can GAD be treated by reducing avoidance of emotional experience?

Answer 37

Exposure. If avoiding emotional experience, must expose client to distress – I’m anxious and I can just sit with it, don’t have to avoid it.

Question 38

How can GAD be treated by reducing avoidance of uncertainty?

Answer 38

Exposure to uncertainty – I’ve done everything I could, and I have to put up with the idea that this bad thing might happen.

Question 39

How can worry be treated according to metacognitive theory?

Answer 39

By challenging the beliefs about worry.

In Type 1 worry, change positive belief that worry is helpful helpful.

In Type 2 worry, challenge the negative belief that worry is bad.

Question 40

What third-wave treatments appear effective for GAD?

Answer 40

Mindfulness and interpersonal therapy

Question 41

What are the treatment outcomes in CBT for GAD?

Answer 41

Treatment effects modest –50-60% no longer score in the clinical range at follow-up