CBT for GAD

Question 1

What is DSM-V criteria for GAD

Answer 1

Excessive anxiety and worry (apprehensive
expectation), occurring more days than not for at
least six months, about a number of events or
activities.
* The person finds it difficult to control the worry.
* The anxiety and worry are associated with three (or
more) of six symptoms (next slide)
* The anxiety and worry cause clinically significant
distress or impairment in functioning
* The disorder should not be due to another
psychological, physiological or medical condition.

Question 2

What are the 3 or more physical symptoms associated with GAD

Answer 2

1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going
   blank
4. irritability
5. muscle tension (including trembling, twitching,
   aching)
6. sleep disturbance

Question 3

What other disorder are paired with GAD?

Answer 3

90% of individuals meeting criteria for GAD
will also have at least one other Axis I diagnosis
(most commonly depression, social anxiety,
panic disorder)
* low self-esteem/ self-confidence is pervasive
* approximately 50% also have Axis II
symptomatology (avoidant/dependent PD)

Question 4

What are some of the risk factors for GAD?

Answer 4

• having a parent who worried a lot (modelling)
• having to cope with sick, absent, abusive
  or aggressive parents at an early age
• being given age-inappropriate responsibility
• being overprotected and not learning to cope
  with life’s ups and downs
• being told that you could not cope with life and
  believing it
• growing up in a chaotic household where no
  one worried - but someone had to

Question 5

How is worry defined?

Answer 5

Worry is a thinking process that involves dwelling on a negative interpretation of future events which leads to the emotional state of anxiety.

Question 6

What makes worry GAD worry?

Answer 6

worries occur across the board and are
not confined to just one or two topics
* worries spiral and chain from topic to topic,
often starting with ‘What if…?’
* content of worries include topics that
non-GAD pts worry about, e.g. family,
work, finances, health, but also
seemingly minor matters, e.g. which
food to buy, which book to read…

Question 7

GAD people tend to live in the future, what impact does this typically have?

Answer 7

difficulty in living in the here and now because
of constant future focus, thereby missing out on
potentially enriching experiences
* poor quality of life because preoccupied with
worrying about either real, or hypothetical
future events
* difficult to enjoy pleasurable events
in the present
* this theme is apparent even at assessment: “Will
this therapy work? What if I don’t feel better?”

Question 8

What are the main cognitive models for treating GAD?

Answer 8

generic cognitive model
(Beck et al., 1985)
metacognitive model
(Wells, 1997, 2000)
intolerance of uncertainty model (most
commonly used in the NHS)
(Dugas et al., 1998)

Question 9

How does Beck et al, 1985, conceptualise self-concept in GAD?

Answer 9

Generalized global view of self as a weakling or inadequate personality – unable to cope with ordinary life demands, expectations and problems
 ‘Inadequate’ performance makes patients feel constantly vulnerable to negative evaluation and rejection
 High self-criticism but more specific/ behavioural and less global than in depression