GAD Flashcards
DSM 5 criteria for GAD
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
1. Muscle tension
2. Restlessness/ keyed up/ on edge
3. Easily Fatigued
4. Irritability
5. Sleep disturbance
6. Difficulty concentrating
Normal worry
Worry confined to relevant topic and controlled
• Minor things do not spiral into major concerns e.g. missing the bus, being 10 minutes late to meet a friend.
• Worry occurs for short periods around or before major life events.
• Worries tend to be fleeting (under an hour).
GAD worry
- Worry broad across a range of topics.
- Worry often reported as uncontrollable.
- Often focuses on the hypothetical future worst case scenario.
- Minor everyday issues spiral quickly to major concerns.
- Future focused the What if?
- Worry is persistent and interferes with everyday
Cognitive Behaviour Model of GAD
Dugas, et al (1998) cognitive behaviour model of GAD.
intolerance of uncertainty
beliefs about worry
poor problem orientation
cognitive avoidance
(last 2 are most relevant to Step 2 GAD intervention).
MR FISC
Symptoms of GAD
- Muscle tension
- Restlessness/ keyed up/ on edge
- Fatigued
- Irritability
- Sleep disturbance
- Concentration impaired
Poor problem orientation
Dugas, et al (1998) cognitive behaviour model of GAD.
Beliefs about the nature of problems e,g, problems are threatening or unfair
Appraisals of themselves as problem solving agents , e.g. doubt their ability to solve problems
Expectations about the outcome of the problem solving process e.g. pessimistic about the outcome
Cognitive avoidance
Cognitive avoidance is a term that represents several strategies, such as distraction, worry, and thought suppression, aimed at avoiding or escaping thoughts about undesirable situations or problems
How does cognitive avoidance maintain worry
Short term decrease in anxiety through not facing your fear (in this case thinking about the uncertain situation)
However likely to:
• Lead to enhancement effects- trying not to think about something makes it harder not to think about it, and rebound effects. ‘Pink elephant’ and ‘monsters under the bed’
• Consolidate negative beliefs about worry (e.g. “worry is uncontrollable”)
LI interventions for GAD
• Psychoeducation – Worry awareness training
• Worry Diary, Classifying worry – worry awareness training
• Worry Tree
Problem Solving – Addresses negative problem orientation.
• Worry Time- addresses cognitive avoidance by exposure to worry
Psychoeducation around worry
Engage in worry process (behavioural response) rather than problem solving
•Engaging in worry can feel like you are doing something helpful.
• Worrying can temporarily remove the negative internal mood state (feel less anxious).
• Worry is therefore maintained by negative reinforcement.
• This leads to worry becoming a habitual strategy to manage threat and anxiety.
•Worry is only useful if it spurs you to take action and problem solve
• Aim is not to get rid of worry but to ‘turn the dial down’ and increase opportunity for alternative behaviours.
other LI interventions for GAD
- Present moment focus – addresses avoidance of worry.
* Progressive Muscle Relaxation – addresses arousal informed by Borkovec (1994) Avoidance Model of Worry and GAD.
Butler and Hope 2007
Worry Tree
• A tool to support the categorising worry by type and prompting action
• Provide a concrete plan and does not rely on affect to guide decision making.
• The goal is to limit the time worrying about hypothetical worry
• Schedule time each day to look at / address worries, “can worry all you want”
• Approx 20 minutes, day time or early evening (not too close to bedtime)
Steps for Worry Time
- When notice you are worrying outside of planned worry time, note down the worry (if at night jot down on paper next to bed)
- After writing down, refocus on present moment and what you were doing before worry came into your mind – remind yourself you can worry as much as you like later on in your planned worry time
- When it gets to planned worry time, let yourself worry! For real event worries – problem-solve. For hypothetical worries, think about how you felt when you wrote it down and how you feel now. Ask yourself whether the worry still matters, whether it will matter in future and whether worrying about it now will change it.
- End worry time with a stimulating activity to shift focus away from worries
