L2 - GAD article Flashcards
Theoretical models of Generalized Anxiety Disorders
- Avoidance model of Worry and GAD (AMW)
- The Intolerance of Uncertainty Model (IUM)
- The Metacognitive Model (MCM)
- The Emotion Dysregulation Model (EDM)
- Acceptance-based Model of Generalized Anxiety Disorder (ABM)
GAD according to the DSM
- proper disorder from DSM-III
- excessive, uncontrollable worry about a variety of topics (…)
- for now, studies seem to suggest that CBT is the most effective treatments
- Avoidance Model of Worry and GAD (AMW)
What is worry according to this model?
- Borkovec, 2004
- verbal linguistic, thought-based activity that inhibits vivid mental imagery and associated somatic and emotional activation
- ineffective cognitive attempt to problem solve and thus remove a perceived threat, while simultaneously avoiding aversive somatic and emotional experiences that would come about from confrontation
AMW - somatic and emotional experiences
- inhibition of somatic and emotional experiences prevents individual from the emotional processing of fear, needed for successful habituation and extinction
- enhancement of somatic and emotional experience can lead to effective processing of emotional cues
(extinction and habituation can come from exposure to fear cues, such as feared stimulus, response to the stimulus, meaning behind the fear)
AMW - the role of beliefs
- catastrophic mental images are replaced by less distressing, less somatically activating verbal linguistic activity
> worry is negatively reinforced by the removal of aversive and fearful images - worry is further reinforced by positive beliefs
> e.g. worry is helpful for problem-solving, motivating performance, and avoiding future negative outcomes
> Positive beliefs are reinforced when negative future events do not occur or are effectively managed
AMW - etiological factors
- poor interpersonal skills
- early lifetime events
> e.g. past traumas and insecure attachment styles
AMW - empirical support
T - worry is verbal-linguistic (and not imagery-based)
T - worry does lower somatic arousal
T - positive beliefs reinforce worry
T - interpersonal problems and insecure attachment syles are important predicting/maintaining factors
- The Intolerance of Uncertainty Model (IUM)
- what is the main point?
- what is the role of worrying?
- Dugas & Robichaud, 2007
- highlights the importance of intolerance of uncertainty as maintaining factor of GAD
> individuals with GAD find uncertain or ambiguous situations to be ‘‘stressful and upsetting’’, and experience chronic worry in response to such situations - worry→ helps coping with feared events more effectively or prevents those events from occurring at all
IUM - what does the worry lead to?
- negative problem orientation and cognitive avoidance
> both serve to maintain the worry - IU directly impact the negative problem orientation, cognitive avoidance and worrying
IUM - empirical support
- 4 factors of GAD: IU, positive beliefs about worrying, cognitive avoidance and negative problem orientation
> IU is only factor specific to GAD, compared to other anxieties
> IU is not specific to GAD (also in depression, etc)
- The Metacognitive Model (MCM)
- Wells
- core: individuals with GAD experience two types of worry:
> Type 1: worry about non-cognitive events, such as external situations or physical symptoms
> Type 2: ineffective strategies that are aimed at avoiding worry via attempts at controlling behaviors, thoughts, and/or emotions
MCM - Types of worry
Type 1
- stimulates anxiety response, but later might lower anxiety if situation has been resolved
- negative beliefs about worry are activated
- start to worry about the worry → leads to type 2 worry
Type 2
- ineffective strategies to control worry, via controlling behaviors, thoughts, emotions
> e.g. reassurance-seeking, checking behavior, thought suppression, distraction, and avoidance of worrisome situations
- these worries prevent from experiencing events that might provide evidence that worry is not dangerous and uncontrollable
- the efforts used by those with GAD to control their thoughts are often unsuccessful
→ this leads to decreased confidence in ability to control worry
→ this reinforces belief that worrying is dangerous and uncontrollable
- The Emotion Dysregulation Model (EDM)
- 4 components:
> emotional hyperarousal
> poorer understanding of their emotions
> more negative attitudes about emotions
> maladaptive emotion regulation and management strategies
! Bidirectional cycle
EDM - intensity of emotions (1)
- lower threshold for the experience of emotion
- emotions occurr more easily and quickly (not more strongly)
- express emotions more frequently (esp. negative ones)
EDM - poor understanding of emotions (2)
- deficits in describing and labeling emotions
- deficits in accessing and applying the useful information that emotions convey
EDM - more negative attitudes about emotions (3)
- from component 1 & 2
- unsuccessful or maladaptive attempts to either minimize emotions or over-control them
- inappropriately express emotional arousal
> e.g., excessive worry, suppression of emotions, emotional outbursts
- Acceptance-Based Model of Generalized Anxiety Disorder (ABM)
- Roemer and Orsillo
1. internal experiences
2. problematic relationship with internal experiences
3. experiential avoidance
4. behavioral restriction (lowered engagement in behaviors/actions once meaningful)
ABM - problematic relationship with internal experiences (2)
2.1 Negatively reacting to internal experiences
- negative thoughts (e.g. judgment of emotional responses as extreme or undesirable) or meta-emotions (e.g., fear of fear) that may arise when an individual has an internal experience
- this leads to difficulties monitoring, accepting, and interpreting emotions
2.2 Fusion with internal experiences
- this is belief that negative reactions to internal experiences are permanent
ABM - summary
- avoidance reduces the distress caused by the internal experience in the short-term
- in the long-term, this avoidance serves to reinforce behavioral restriction as the individual becomes less engaged in activities that he/she finds valuable
- this results in increased distress that can trigger more negative internal experiences
= thereby perpetuating the cycle
