Week 4: GAD

Question 1

Define Worrying

Answer 1

A chain of catastrophizing thoughts that are predominantly verbal.

Question 2

In GAD, how is worrying experienced?

Answer 2

-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.

Question 3

What are the main characteristics of GAD? (3)

Answer 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

Question 4

True or false:
People with GAD can experience panic attacks.

Answer 4

True
People with GAD can have panic attacks, but PD is short and intense.

Question 5

What is the difference between GAD-worrying and other kinds? (2)

Answer 5

1) negative metacognitions about worrying

2) Worrying constantly switches to different topics

Question 6

How effective is CBT at treating GAD?

Answer 6

At most 50% recovery

Question 7

Which CBT model of GAD is most effective at this time?

Answer 7

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.

Question 8

What is the key factor to focus on in the meta-cognitive model?

Answer 8

The processes that play a role in developing and maintaining the worrying.
-Metacognitions

Question 9

Two types of metacognitions

Answer 9

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

Question 10

What are maintaining factors of negative metacognitions? (3)

Answer 10

◦ Avoidance/safety behaviour
◦ Attempts to control worrying
◦ Emotional processes

Question 11

In the metacognitive model, how would you identify a triggering event?

Answer 11

Ask:
“What was the first thought you had when you started worrying?”

Question 12

What is the general priority order when conducting metacognitive therapy?

Answer 12

General order:
1. Uncontrollability
2. Danger of worrying
3. Positive metacognitions
4. Expanding coping mechanisms

Question 13

What kinds of behavioural experiments can address negative metacognitions? (3)

Answer 13

Postponing experiment

“Worrying worse” experiment
-Challenging clients to worrying as much as possible to test expectations
–going mad
–physical problems

Mini-Interviews

Question 14

What kinds of behavioural experiments can address positive metacognitions?

Answer 14

Minimal vs. maximal worrying-experiment

Question 15

How long must “worry” be present until GAD diagnosis criteria is met?

Answer 15

6 months

Question 16

Why is GAD poorly recognized in clinical practice? (2)

Answer 16

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

Question 17

How is worrying reinforced?

Answer 17

1. Positively as it results in a decreased physiological and emotional response
2. Negatively as the feared catastrophes generally don’t come true
   Leads to beliefs of worrying as a helpful strategy

Question 18

How are “obsessions” different in GAD from OCD? (5)

Answer 18

a. Egosyntonic (“this is who I am”)
b. less undesirable
c. realistic
d. verbal-linguistic
e. worry about a wide variety of issues

Question 19

How to distinguish GAD and MDD? (3)

Answer 19

1. Focus in time of the repetitive thoughts
   -GAD: negative things that might happen in the future
2. Somatic symptoms only present in GAD
3. Presence of depressed mood in MDD. In GAD people speak of feeling sad & key
   characteristic is anxiety.

Question 20

When treating GAD with CBT, can one expect MDD symptoms to also reduce?

Answer 20

Yes

A striking finding of the present meta-analysis was the large overall effect size for the treatment effects on depression

Question 21

True or False:
Applied relaxation is effective at treating GAD

Answer 21

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.