Week 2: Key reading BEHAR 2009 Flashcards
what are the 5 contemporary models of GAD?
Avoidance model of worry and GAD (AMW)
The tolerance of uncertainty model
the metacognitive model (MCM)
the Emotion Dysregulation Model (EDM)
acceptance-based model of generalised anxiety disorder
Avoidance model of worry and GAD (AMW)
- facts
○ Based on Mowrer’s (1947) 2 stage theory of fear
○ Worry is a verbal linguistic, thought-based activity that inhibits vivid mental imagery and associated somatic and emotional activation
○ Experience of worry become negatively reinforced
○ Insecure attachments and past trauma cause GAD sufferers to not have adequate resources to cope
Avoidance model of worry and GAD (AMW)
support
○ Evidence supporting that worry is a verbal linguistic rather than imagery based process
○ Worry does dampen somatic arousal at rest and upon threat exposure
○ GAD may cause extra time needed for arousal levels to fall to normal suggesting prolonged hyporesponsiveness
○ Insecure attachments common in GAD
○ Worry about interpersonal difficulties
§ Predict poor outcome following CBT
Avoidance model of worry and GAD (AMW)
treatment
○ Based on central tenets of AMW
○ Self-monitoring, relaxation techniques, self-control desensitization, gradual stimulus control, cognitive restructuring, worry outcome monitoring, promotion of present-moment focus of attention, expectancy-free living
○ Addition of interpersonal functioning and emotional processing to CBT did not enhance treatment efficacy however there was a higher rate of high end state functioning
The tolerance of uncertainty model (IUM):
facts
○ Individuals with GAD find uncertain or ambiguous situations to be stressful and upsetting and experience chronic worry in response
○ Worrying and anxiety lead to negative problem orientation and cognitive avoidance
§ Lack confidence in problem solving
§ Perceive problems as threats
§ Become easily frustrated with dealing with problems
§ Pessimistic about outcome
○ IU serves to set off the chain of worrying, negative problem orientation and cognitive avoidance and argue that intolerance of uncertainty also directly effects problem orientation and degree of cognitive avoidance.
The tolerance of uncertainty model (IUM):
support
○ Importance of 4 factors to distinguish GAD from controls:
§ IU, positive beliefs about worry, cognitive avoidance, negative problem orientation
○ IU was specific to GAD
○ IU and negative problem orientation predicted GAD symptoms
○ IU also in OCD
The tolerance of uncertainty model (IUM):
treatment
○ Developing increased tolerance for and acceptance of uncertainty
The metacognitive model (MCM):
facts
○ People with GAD experience 2 types of worry
§ Type 1 worry - worry about non-cognitive events
§ Type 2 worry - worry about worry
The metacognitive model (MCM):
support
○ GAD experience more type 1 worry than usual
The metacognitive model (MCM):
treatment
○ Alter type 2 worry
○ Altering cognitions related to reliance on worry as a positive force in life
○ Case formulation, socialisation, discussion
The emotion dysregulation model (EDM):
facts
○ 4 central components
§ Emotional hyperarousal
§ Poorer understanding of emotions
§ More negative attitudes about emotions
§ Maladaptive emotion regulation and management strategies
The emotion dysregulation model (EDM):
support
○ More intense negative emotions than healthy controls
The emotion dysregulation model (EDM):
treatment
○ Combination of CBT elements
○ Emotion regulation therapy
Acceptance-based model of generalised anxiety disorder:
facts
○ 4 components:
§ Internal experiences, problematic relationship with internal experiences, experiential avoidance, behavioural restriction
Acceptance-based model of generalised anxiety disorder:
support
○ Experential avoidance and negative reactions to emotions are psotiviely associated with GAD symptom severity in non-clinical sample
