Anxiety Disorders: GAD

Question 1

What did the DSM-4 ‘Anxiety Disorders’ chapter include?

Answer 1

Separation Anxiety Disorder; 
Specific Phobia; 
Social Phobia; 
Generalised Anxiety Disorder; 
Panic Disorder (with/without Agoraphobia);
Post-Traumatic Stress Disorder; 
Acute Stress Disorder; 
Obsessive-Compulsive Disorder.

Question 2

What does the DSM-5 ‘Anxiety Disorders’ chapter include?

Ordered in age of onset

Answer 2

Separation Anxiety Disorder;
Selective Mutism;
Specific Phobia;
Social Phobia;
Generalised Anxiety Disorder;
Panic Disorder;
Agoraphobia.

Question 3

How does a clinician know when to treat a ‘fear’ or ‘anxiety’?

Answer 3

When the ‘fear’ or ‘anxiety’ becomes extreme and disruptive.

Question 4

What are some maintaining factors for fear and anxiety?

Answer 4

Avoidance;
overestimating the cost;
overestimating the likelihood.

Question 5

When is GAD generally first reported?

Answer 5

In the persons 30’s but many report having always been a worrier.

Question 6

When was GAD first introduced? And how was it described?

Answer 6

In DSM-3 (1980) & described as ‘excessive, irrational worry’.

Question 7

What change about the definition of GAD was made from DSM-3 to DSM-4 &-5?

Answer 7

From being described as ‘irrational’ worry to uncontrollable worry occurring more often, at a greater intensity and about a variety of events/outcomes.

Question 8

What are the criterion for GAD?

what does it feel like, how often does it occur, for how long?

Answer 8

People feel as though they cannot stop worrying, there is always something to worry about.
It occurs most days then not, for at least 6 months.

Question 9

Does GAD include autonomic or somatic symptoms?

Answer 9

Somatic symptoms related to tension - (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance).

Question 10

How is GAD distinguished from other ‘Anxiety Disorders’ that involve excessive worrying?

Answer 10

Other anxiety disorders involve worry that is focused on one thing.
GAD is a free-floating worry that transfers from one thing to the next.

Question 11

For young adults vs. older adults, what is ‘normal’ worry focused on?

Answer 11

Young adults: social threat;

older adults: physical threat.

Question 12

What is a defining feature of the mental aspect of worrying?

Answer 12

People tend to worry in words (not images), it contains mental chatter.

Question 13

People with ‘normal’ worry, use it to:

Answer 13

Solve problems, motivate action.

Question 14

When people with ‘normal’ worry solve a problem, what do they do?

Answer 14

Stop worrying.

Question 15

What do Problem Solving Theories involve?

Answer 15

Pathological worriers cannot solve a problem because they find more things to worry about in the solution (‘catastrophising’).

Question 16

In Problem Solving Theories, what does the act of problem solving become?

Answer 16

An avoidance behaviour.

Question 17

Why does Avoidance Theory involve ideas about ‘imagery’ vs. ‘verbal thought’.

Answer 17

Because ‘imagery’ evokes stronger emotions then ‘verbal thought’, thus in order to AVOID feeling negative, the worrier thinks in words.
Reducing imagery is an attempt to reduce discomfort.

Question 18

In Avoidance Theory, using ‘imagery’ to cognitively avoid anxiety causes what problems?

Answer 18

It interferes with emotional processing and the fear structures are maintained.

Question 19

In Experiential Anxiety Theory, what is incessant worrying associated with?

Answer 19

Worry is associated with a ‘fear of anxiety’ and an ‘anxiety sensitivity’.

Question 20

In Experiential Anxiety Theory, what do high worriers have an intolerance to and what do they avoid?

Answer 20

They have an intolerance to stress and they avoid internal experiences.

Question 21

What is the Intolerance of Uncertainty theory?

Answer 21

Is characterises how worriers try to avoid uncertainty by always thinking about the future.
They aim to reduce uncertainty to zero - but this is impossible so the worrying never ends.

Question 22

When given a choice between an ‘uncertain outcome’ that could be good or bad, and a ‘certain outcome’ that is definitely bad, what do people with GAD choose?

Answer 22

The ‘certain outcome’, even if it is bad.

Question 23

What are the two types of worry involved in Metacognitive Theory?

Answer 23

Type 1 worry (‘normal’);

type 2 metaworry (‘abnormal’).

Question 24

What does Type 1 worry in Metacognitive Theory involve?

Answer 24

It is ‘normal’ worry, whereby the person understands that worrying is helpful if there is a solution. Once the solution is found and implemented, they will stop worrying.

Question 25

What does Type 2 metaworry in Metacognitive Theory involve?

Answer 25

It is ‘abnormal’ worry, where the person is worried about worrying. They try to stop worrying in an ineffective way and ultimately feel more out of control and anxious.

Question 26

Why is it difficult to treat GAD?

Answer 26

It’s hard as the target of worry constantly changes. Must look at the actual mechanism of worrying and change the cognitive behaviour.

Question 27

How to treat Biased Threat Perception?

Answer 27

Help the person understand that they are overestimating the probability/cost of a threat.

Question 28

How to treat GAD with ‘problem solving’?

Answer 28

By giving structured ‘problem solving’ training and getting them to think positively about a solution.
Focus on what could go RIGHT (not just wrong).

Question 29

How to help those with GAD stop ‘avoiding’?

Answer 29

Forcing them to process their fears and anxiety emotionally, and realised that the ‘avoided’ outcome is not so bad.
Help them realise they CAN tolerate emotions and learn how to regulate them.

Question 30

Is giving someone with GAD ‘structured worry time’ a good idea?

Answer 30

Yes, as they learn to not worry in other times of the day.

Question 31

What does Metacognitive theory say about treating GAD?

Answer 31

Need to challenge beliefs about the actual ‘worrying’. Help them understand that worrying is not that bad if it is done in a healthy way - so they let go of the anxiety surrounding worrying.

Question 32

What is the improvement of treated GAD at a 6-month follow-up?

Answer 32

50-60%.