GENERALISED ANXIETY DISORDER (GAD)

Question 1

GAD - DSM-5

Answer 1

• excessive anxiety/worry that’s difficult to control and interferes with everyday functioning
• must happen most days and persist over 6 months

Question 2

GAD must be characterised by 3 or more of the following:

Answer 2

• restlessness
• tiring easily
• difficultly concentraring
• irritability
• muscle tension
• sleep disturbance

Question 3

associated features and disorders of GAD

Answer 3

• muscle tension resulting in trembling, twitching, aches, soreness
• somatic symptoms
• depressive symptoms common
• often co-occurs with mood disorders, other anxiety disorders, substance abuse and stress

Question 4

genetics

Answer 4

heritability low - 28% (bienvenu et al., 2011)

genetic link unlclear

Question 5

impact of life events - traumatic events

Answer 5

• sexual abuse during childhood increases risk (bulik et al., 2001)
• however, abuse rare and GAD common

Question 6

impact of life events - parenting styles

Answer 6

parental rejection = risk factor (Newman et al., 2013)

Question 7

impact of life events - parenting modelling

Answer 7

parental anxious behaviour found to precede the same in children

Question 8

cognitive avoidance mdoel

Answer 8

• function of worry suppresses emotional processing of fear
• worry as a way of controlling negative emotions
• for fear to be extinguished people must experience this emotional distress

Question 9

support for cognitive avoidance model

Answer 9

• neurophysical experiments shown that worrying leads to reduce physiological arousal (Borkovec + Hu, 1990)
• GAD sufferers reported they engage in worrying because it prevents them from thinking about event aht causes fear (Borkovec, 1994)

Question 10

contrast avoidance model

Answer 10

• worry to maintain negative state - preparing for the worst
• those with GAD, hypersensitive to shifts in negative emotion, use worrying to maintain negativity to avoid shifts
• evidence for and against is limited

Question 11

assessment of GAD

Answer 11

GAD-7
penn state worry questionnaire
metacognition questionnaire

Question 12

GAD-7

Answer 12

measures frequency of cognitive/somatic symptoms

Question 13

penn state worry questionnaire

Answer 13

measures excessiveness and uncontrollable state of worry

Question 14

metacognition questionnaire

Answer 14

measures individual beliefs, judgements and tendencies across series of domains

Question 15

CBT for GAD

Answer 15

• education
• self-monitoring
• relaxation training
• cognitive restructuring
• exposure

Question 16

is CBT for GAD effective?

Answer 16

• 38% of patients recovered after 6 months (Durham, 2007)
• more effective than psychoanalytical therapy and behaviour therapy
• effects last longer than drug treatments alone? (cujipers, 2014)

Question 17

drug treatments for GAD

Answer 17

• SSRIs
• SNRIs
• benzodiazepine
  more likely to refuse treatment if offereed drugs alone

Question 18

combination therapy for GAD

Answer 18

• recommended when GAD is complex, refractory or when functioning highly impaired
• evidence is lacking
• side effects more likely

Question 19

metacognitive therapy for GAD

Answer 19

• focus on metacognitions that give rise to thinking

- challenging beliefs about cognitions

Question 20

acceptance and commitment therapy for GAD

Answer 20

• promotes psychological flexibility

- encourages defusion and acceptance of internal experience