generalised anxiety disorder

UCP

DSM-5 anxiety disorders

some of the most common psychiatric disorders, around 28% of people report general anxiety symptoms. includes

• specific phobias

• social anxiety disorder

• panic disorder

• agoraphobia

• generalised anxiety disorder

definition of GAD

• excessive worry that interferes with everyday functioning

• associated with high levels of distress, concentration problems, sleep disruption, and restlessness

• similar diagnosis between DSM and ICD

• symptoms must happen most days and over +6 months

• must have a detrimental effect on everyday life and be no better explained by another diagnosis

general criteria for anxiety disorders

• marked avoidance of a situation in which negative outcomes could occur

• time and effort spent preparing for situations that might have a negative outcome

• procrastination

• difficultly making decision

• repeatedly seeking reassurance

ICD diagnostic criteria

• a period of at least 6 months with prominent tension, worry, and feelings of apprehension about everyday events and problems

• at least one of the following four symptoms are present, one of which from (1)

1. palpitations, pounding heart, sweating, trembling, shaking, dry mouth

2. difficultly breathing, feeling of chocking, chest pain/discomfort, nausea/abdominal distress, feeling dizzy, faint/light-headed, feeling objects are unreal, feeling ones self is distant, fear of losing control, going crazy, or passing out

exclusion criteria

• focus of the anxiety and worry is confined another axis 1 disorder (e.g. only about social situations, or a specific phobia)

• if the disturbance is a result of a general medical condition or effects of a substance

• if worry occurs exclusively during a mood disorder, a pervasive developmental disorder, or a psychiatric disorder

epidemiology

• ratio of female to male sufferers is ~2:1

• lifetime prevalence of 3.7%

• lifetime prevalence is highest in HICs (~5%)

• lifetime comorbidity: 81%- up to 90% of people with GAD will suffer from a different psychological disorder as well, and in many cases GAD will precede the onset of the other disorder

gender differences

• women are twice as more likely than men to have an anxiety disorder

• women may be more likely to report symptoms

• men more likely to be encouraged to face fears

• women more likely to experience childhood sexual abuse

• women show more biological stress reactivity

cognitive model of pathological worry

cognitive biases:

• attentional bias- tendency to pay more attention to negative or threatening stimuli at the cost of positive info

• interpretational bias- tendency to interpret neutral stimuli in a negative or threatening manner

attentional control:

• we have a limited cognitive capacity and we can exert goal directed control over our allocation of attention

• worrying takes more resources and impairs control of threatening stimuli

intolerance of uncertainty model of GAD

individuals with GAD have a greater need for certainty than others. uncertainty and ambiguity may be perceived as more unpleasant by individuals with GAD

• positive beliefs about worry- its useful, important, and necessary to prevent surprise

• negative problem orientation- dysfunctional attitudes, perceptions of problems as threats, lack of self-confidence in problem solving skills

• cognitive avoidance- worry avoid emotional arousal, suppresses negative intrusive thoughts

avoidance model of GAD

• worry involves perceived danger rather than danger that exists, so there is no real threat or danger

• no effective fight or flight response, only has mental efforts to solve the problem

• worry masks the fear you would feel

• when negative future events do not occur or are effectively manages, it reinforces the worry response

meta-cognitive model of GAD

• we worry because we cognitively appraise situations as threatening, even when they are not

• not able to stop thinking about worrying

• thinking about worrying increases the effect of worrying

interventions

follows NICE guidelines, which propose a joint approach of working with the person and their families

• education about GAD

• CBT intervention

• worry awareness training

• coping with uncertainty

• re-evaluating negative beliefs about the usefulness of worry

• processing core fears through imaginal exposure