Anxiety and GAD Flashcards
We become anxious when we perceive a ______. It’s a normal, _________ response to protect us from harm. Anxiety is on a _______ from normal to abnormal. It is classified as abnormal when the behaviour used to reduce the anxiety is ________, and interferes with daily life and/or the fear is ________. The thing that maintains anxiety is _______, which ________ reinforces the behaviour.
threat, evolutionary, spectrum/continuum, dysfunctional, misplaced, avoidance, negatively
In the DSM-IV separation anxiety was only available to _______. It is now available to ______ as well.
children, adults
In specific phobia, there are some things that humans are more ______ wired to fear, such as snakes
biologically
GAD does not have a specific ____ in mind. They worry about a _____ of things.
fear, variety
OCD and PTSD now have their ______ ______ in the DSM-V
own chapters
In the DSM-IV, agoraphobia was seen as a complication of _____ _____. In the DSM-V it is listed _____, as there could be other reasons why one would not leave their house.
panic disorder
separately
GAD does not include ______ ______ symptoms. This is because their _____ anxiety is higher generally
autonomic arousal, baseline
How is the worry in GAD difference from normal worry?
Normal worry is due to a perceived future threat.
Usually, people see worry as useful as it:
- motives action
- helps avoid negative outcomes
- promotes problem solving
People manage worry with:
- social support
- distraction
- problem solving
They are able to stop worrying
Normal worry has more verbal thought than imagery
Describe the Problem Solving Theory of GAD
- Problem solving in people with GAD is unsuccessful.
- People with GAD have more problems to start with (as their threat perception is biased and may see threat in ambiguous situations - likelihood and cost judgement)
- Because of their biased threat perception, any potential solutions they find to problems they deem as problematic. They always find problems with the solutions they generate and do not select one. So they have issues with:
- solution evaluation and
- solution selection
They are good at generating solutions, but not solution evaluation or selection
negatively biased threat perception and negatively biased evaluation process
Describe the Avoidance Theory of GAD (Borkovec 1994)
Two observations
1. worry has more verbal thought than imagery - because images of negative outcomes are very aversive (easier to switch to verbal thinking). Images are unpleasant and the anxiety associated with those images are unpleasant
- GAD is associated with tension, not autonomic arousal - people switch from imagery to verbal worry. Better to feel tense than really scared. This is because the very FUNCTION of worry is to reduce autonomic arousal
So, worry has the function of cognitive avoidance. People want to avoid negative images AND anxious arousal (because it’s unpleasant). This avoidance maintains fear of negative images and anxious arousal.
Describe “experiential avoidance” and how this support Borkovec’s theory
- Worriers (potentially GAD, we’re not sure) scored higher in anxiety sensitivity - less tolerant of anxiety symptoms
- Worriers are more distressed about things generally (lower distress tolerance - upset, angry, sad, etc)
- Worriers avoid internal experiences (experiential avoidance). Don’t like to be anything different than “calm” - excitement/happiness is bad too because after you’ll feel sad - they dislike the feel of emotional bodily sensation
- Worries also have more difficulty identifying, tolerating and regulating emotions,
- -> hard to know if this difficulty causes worry (because they’re not sure how they feel, or maybe they use worry as their only skill to regulate emotions?
Another theory for worriers/GAD is _______ of uncertainty. This states that ____ is a way to reduce uncertainty. This leads to a preoccupation with _____ and interferes with _____ _____. Worriers aim to _____ ____ to zero, and do not ____ unless they are _____% certain of something. However no potential solution is 100% safe, so they keep ______.
intolerance, worry, details, problem solving, reduce uncertainty act, 100 worrying
Describe the Metacognitive Theory of Worry
There are two types of worry:
Type I worry - normal worry - perceived threat + worry = potential solution
Positive beliefs about worry - helps you solve problems - after you solve the problem/gain reassurance - worry goes away
Type II worry - worry is harmful –> metaworry –> ineffective thought control strategies –> increased anxiety/worry (cycle continues)
negative beliefs about worry (makes me go mad, I get sick with too much worry) - we worry about worrying - then we try to suppress the thoughts, etc. Of course this fails and you end up worrying even more because you cannot control the worry.
Where things go wrong, is when you trying to solve a problem (type I worry) but also have negative beliefs about worry (type II worry). This interferes with problem solving/reassurance so you cannot stop worrying.
In treatment, similar to other anxiety disorders, we have to attack ______ with ______. However, we don’t exactly know what these people with GAD are trying to ______
avoidance with exposure
avoid
How effective is treatment?
Modest - 50-60% improvement
