*Lecture 5 - Generalised Anxiety Disorder (GAD)

Question 1

What are the 4 steps in social problem solving?

According to D’Zurilla & Maydeu-Olivares, 1995

Answer 1

1: problem definition
2: generation of alt. solutions
3: solution evaluation (positive/negative)
4: solution selection

(The last two stages are problematic in higher worriers)

Question 2

What are the DSM-5 Anxiety Disorders?

Hint: there are 7

Answer 2

 Separation Anxiety Disorder
 Selective Mutism
 Specific Phobia
 Social Anxiety Disorder (Social Phobia)
 Panic Disorder
 Agoraphobia
 Generalized Anxiety Disorder

Question 3

What is Anxiety?

Answer 3

• often labelled fear or panic (panic is very high level of anxiety)
• activated in response to perceived threat
• involves three interrelated systems (see card 5)

Question 4

What are the three interrelated systems involved in anxiety?

Answer 4

1. Physical
   - fight/flight: sympathetic nervous system
   - mobilises resources to deal with the threat
   - symptoms: sweating, heart rate, trembling etc.
2. Cognitive
   - perception of threat
   - attentional shift and hyper-vigilance,
   - difficulty concentrating on other info
3. Behavioural
   - escape/avoidance tendencies
   - aggression

Question 5

True or False?

The experience of anxiety is the same in normal and abnormal anxiety (qualitatively the same).

Answer 5

True

Question 6

What is the first line of treatment for Social Anxiety?

Answer 6

Cognitive Behavioural Therapy (CBT)

Question 7

List six methods of CBT that can help with Social Anxiety.

could change q. to inc. an explanation

Answer 7

1. psychoeducation about maintaining factors
2. cognitive challenging negative thoughts
3. behavioural experiments
4. reducing safety behaviours
5. attention training
6. video feedback

Question 8

Generalised Anxiety Disorder first appeared in:

a) DSM I
b) DSM II
c) DSM III
d) DSM IV
e) DSM V

Answer 8

c) GAD first in DSM-III-R (1980)
HOWEVER
the definition changed in DSM-IV (1994) and DSM-5 (2013)

Question 9

FIX CARD

Outline Avoidance Theory.

Answer 9

Worry contains relatively more verbal thought than imagery
 Images of possible negative event are highly aversive
 Cause anxiety symptoms
 Anxiety symptoms are highly aversive
 Reduced imagery => reduced arousal/anxiety
 GAD is associated with tension symptoms
 Worry = cognitive avoidance (Borkovec, 1994)
 Cognitive avoidance interferes with emotional
processing
 fear structures are maintained

Question 10

FIX CARD

What is Experiential Avoidance?

Answer 10

Worry is associated with
 Fear of anxiety/Anxiety sensitivity (Buhr & Dugas, 2009)
 Distress intolerance (Huang, Szabo & Han, 2010)
 Experiential avoidance (Hayes et al 1996)  Worriers avoid internal experiences
 Difficulties in emotion regulation
 Worriers have difficulties in
 clearly identifying emotion,
 tolerating emotion,
 modulating emotion
 Mennin et al., 2005, Roemer et al., 2005

Question 11

What is the Intolerance of Uncertainty Theory?

Ladouceur et al., 2000

Answer 11

 Uncertainty reflects badly on a person, causes
frustration and stress, and prevents action
 Worry to reduce uncertainty
 Leads to preoccupation with details
 Interferes with problem solving
 Worriers aim to reduce uncertainly to zero
 not possible => keep worrying

Question 12

Outline Metacognitive Theory?

Answer 12

Worry (Type 1) and Metaworry (Type 2) (Wells, 1995, Wells & Carter, 2001)

Type 1 Worry:
 Perception of threat + positive beliefs about worry
==> worry to cope with threat
 possible exit by problem solving or reassurance

Type 2 Metaworry:
 Worry + negative beliefs about worry ==> metaworry ==> ineffective thought-control strategies ==> increased anxiety and worry
 Excessive and uncontrollable worry

Question 13

How should one treat biased threat perception?

Answer 13

Cognitive challenging: examine the probability and cost judgments

Question 14

How should one treat avoidance?

Answer 14

Exposure therapy.
 Exposure to vivid images of feared event
 Exposure to emotional experience / distress
 Exposure to uncertainty

Question 15

How well do treatments work?

Answer 15

Treatment effects have been modest

About 50 – 60 % improvement at follow-up