Week 4: GAD Flashcards
Define Worrying
A chain of catastrophizing thoughts that are predominantly verbal.
In GAD, how is worrying experienced?
-It is intrusive and controllable although it is often experienced as uncontrollable.
-Associated with a motivation to prevent or avoid potential danger.
-Worry itself may be viewed as a coping strategy but can become the focus of an individuals concern.
What are the main characteristics of GAD? (3)
The presence of excessive anxiety and worry about a variety of topics, events, or activities > 6 months present, more often than not
The worry is experienced as very challenging to control
Additional anxiety-related symptoms
True or false:
People with GAD can experience panic attacks.
True
People with GAD can have panic attacks, but PD is short and intense.
What is the difference between GAD-worrying and other kinds? (2)
1) negative metacognitions about worrying
2) Worrying constantly switches to different topics
How effective is CBT at treating GAD?
At most 50% recovery
Which CBT model of GAD is most effective at this time?
Metacognitive theory and treatment (Wells, 1995)
- MCT is significantly more effective than other GAD specific CBT
- MCT is very effective in terms of clinical significance.
What is the key factor to focus on in the meta-cognitive model?
The processes that play a role in developing and maintaining the worrying.
-Metacognitions
Two types of metacognitions
Positive metacognitions
-The reason why people worry
“I worry, in order to be better prepared,”
-Leads to worrying about different topics
Negative metacognitions
-The reason why people seek treatment
“I can’t control my thoughts,”
“I can’t sleep because I keep worrying”
-Leads to worrying about worrying
What are maintaining factors of negative metacognitions? (3)
◦ Avoidance/safety behaviour
◦ Attempts to control worrying
◦ Emotional processes
In the metacognitive model, how would you identify a triggering event?
Ask:
“What was the first thought you had when you started worrying?”
What is the general priority order when conducting metacognitive therapy?
General order:
1. Uncontrollability
2. Danger of worrying
3. Positive metacognitions
4. Expanding coping mechanisms
What kinds of behavioural experiments can address negative metacognitions? (3)
Postponing experiment
“Worrying worse” experiment
-Challenging clients to worrying as much as possible to test expectations
–going mad
–physical problems
Mini-Interviews
What kinds of behavioural experiments can address positive metacognitions?
Minimal vs. maximal worrying-experiment
How long must “worry” be present until GAD diagnosis criteria is met?
6 months
Why is GAD poorly recognized in clinical practice? (2)
People with GAD often don’t seek help for their anxious apprehension.
a. Unstructured interviews not suitable as diagnostic tool. Focus only on main complaint
High prevalence of comorbidity
a. MDD (highest) and other anxiety disorders
How is worrying reinforced?
- Positively as it results in a decreased physiological and emotional response
- Negatively as the feared catastrophes generally don’t come true
Leads to beliefs of worrying as a helpful strategy
How are “obsessions” different in GAD from OCD? (5)
a. Egosyntonic (“this is who I am”)
b. less undesirable
c. realistic
d. verbal-linguistic
e. worry about a wide variety of issues
How to distinguish GAD and MDD? (3)
- Focus in time of the repetitive thoughts
-GAD: negative things that might happen in the future - Somatic symptoms only present in GAD
- Presence of depressed mood in MDD. In GAD people speak of feeling sad & key
characteristic is anxiety.
When treating GAD with CBT, can one expect MDD symptoms to also reduce?
Yes
A striking finding of the present meta-analysis was the large overall effect size for the treatment effects on depression
True or False:
Applied relaxation is effective at treating GAD
True-ish
As indicated earlier, our results also suggest that CBT and relaxation may be equally effective in the short-term, but that CBT may be more effective in the longer-term.
