Chapter 4: Generalized Anxiety Disorder

According to the DSM-V, what is the central feature of Generalized Anxiety Disorder (GAD)?

excessive worrying, occurring on more days than not, about a number of events, activities, or topics. worrying must persist for at least 6 months, and can involve a wide variety of topics such as work, school, finances, health, safety, and minor matters.

In what specific ways to cognitions (i.e., thoughts) observed in individuals with GAD different than anxiety-related thought observed in other anxiety disorders, such as panic and social phobia?

more future oriented worries.

Do worries in GAD differ in content from worries observed in non-clinical samples? What features differentiate worries found in GAD from normal worries?

no. worries typically seen in GAD are indistinguishable in content from those reported by nonclinical samples. Worries in GAD have increased frequency and intensity, and the individual's perceived inability to control the worry.

What changes were made to the GAD diagnosis in the DSM-III-R and why was this important?

worry became the central feature of GAD, with excessive worry about at least two life circumstances having to be present.
symptoms had to be present for at least 6 months, raising the stringency for meeting criteria for GAD. Although establishing a minimum 6-month duration of symptoms appeared to be a reasonable strategy for increasing the meaningfulness of the diagnosis, more recent research questions whether this duration is necessary.

What types of life impairment are associated with GAD?

functional impairments similar to that of individuals with depression. severe disability across all domains, but particularly in the area of romantic relationships. People with GAD also report higher work absences and more health care visits. Lower overall quality of life and life satisfaction on a wide range of indices, including self-esteem, work, health, and social relationships.

What did Blazer, Hughes, and George (1987) define a stressful life event and what did they find with respect to their associations with GAD?

an early study found that the presence of at least one stressful life event defined as unexpected, negative, and very important was associated with an increased risk of developing GAD symptoms.

Data suggest that those with GAD have similar problem-solving abilities as those without GAD. In what ways do the problem-solving orientation in GAD differ from normal controls with respect to: (a) negative problem orientation, (b) time management behaviors (inclusive of structure and purpose), and (c) responses to chronic worry?

-negative problem orientation refers to low confidence about one's abilities to solve problems. Individuals with GAD tend to have a more negative problem orientation than individuals with other anxiety disorders.
-worry has been found to have no relationship with time management behaviors (setting goals, organizational skills), but does have a negative relationship with time structure and purpose (possesing the notion that one's time use has a purpose, being present-focused, demonstrating persistence when completing tasks)
-individuals with GAD reported a greater use of worry (thinking about more minor problems) and self punishment (shouting at oneself) strategies than did non anxious controls, and less use of distraction strategies.

Define probability overestimation and catastrophizing as they relate to GAD.

-probability overestimation: thinking a feared consequence is more likely to occur than it really is
-catastrophizing: assuming that an outcome will be much less manageable than it actually is.

What is the basic premise of the cognitive avoidance theory of worry? How is this theory supported by findings on (a) the verbal nature of worry and (b) worry as distraction.

a. the cognitive avoidance theory of worry proposes that worry is an attempt at cognitive avoidance, which is similar in function to the behavioral avoidance seen in many types of anxiety disorders. (the verbal activity of worry distracts from the experience of fear.
b. verbal recounting of feared material is thought to produce less sympathetic nervous system response than imagining feared images. Worry in the face of threat would be negatively reinforced because it allows a person to experience a reduction in distress and arousal in the short term when confronted by a stressful trigger.
c. those with GAD use worry to distract themselves from emotional topics. An individual with GAD might worry about a number of topics (work, relationships, finances) to avoid confronting in depth the emotions associated with his or her most feared scenario.

What is Newman and llera's (2011) extension to the cognitive avoidance theory? According to them, what might be reinforcing about worry?

their contrast avoidance model draws on evidence that worry does not necessarily enable avoidance of negative emotional experiences; instead, individuals with GAD use worry to avoid sharp increases in negative emotions, also known as negative contrast. THey posited that the chronic distress associated with worry helps individuals prepare for negative events, and precludes an increase in distress should the negative outcome occur.

What family and parenting factors have been associated with the development of GAD?

-people with GAD may have experienced unpleasant, negative, and rejecting family environments.
-relationship between perceived parental alienation and rejection, and GAD symptoms
-bidirectional relationship between perceived father-adolescent attachment relationships and GAD symptoms, but an unidirectional relationship for the mother-adolescent attachment relationship, with GAD symptoms leading to a lower quality relationship. the effects of attachment are more nuanced than previously believed.