Generalized Anxiety Disorder

Categorized by

Ongoing and excessive worry about many events and activities

• Health

• The future

• Safety

• Being late

• School

• Disasters

Features of GAD

• Catastrophizing

• Likelihood overestimation

• Low coping self-efficacy

• Difficulty controlling worry

• Reassurance-seeking

• Perfectionism

DSM-5 Generalized Anxiety Disorder (GAD) Diagnostic Criteria

• Excessive anxiety or worry

• Variety of situations

• Most days, hours every day

• At least 6 months

• Impairing/distressing

• At least 3 associated symptoms

  • Examples:

    • Restless, wound-up, or on-edge

    • Difficulty concentrating

    • Being irritable

    • Muscle tension

    • Sleep problems

Cognitive Distortions

• Irrational thoughts that shape how you see the world, how you feel, and how you act

• All people have distorted cognitions sometimes, but they are more prevalent and exaggerated in people with anxiety and depressive disorders

Examples of Types of Cognitive Distortions

• All or nothing thinking

• Overgeneralization

• Personalization

• Catastrophizing

• Mind reading

• Mental Filter

• Fortune Telling

• Emotional reasoning

Intolerance of Uncertainty

• A dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications

• An underlying fear of the unknown

• Desire predictability, freeze up in the face of uncertainty

GAD: Preevalence

• 12-month prevalence 1.2% - 2.9%

• Age of onset

  • Wide range: adolescence to adulthood

• Comorbidity is common

• Severe GAD tends to persist over time

  • Full remission is uncommon

Anxiety and the brain

• What happens in the brain and body during the fight or flight response?

  • High alertness, attentional system changes, release of stress hormones, body is flooded with different chemicals, increased heart rate and blood pressure, sweating, dilated pupils, tense muscles

• How might the brain differ in structure and function for someone with anxiety disorder?

  • Overactive amygdala, fight or flight response may last longer than needed, vmpc doesn’t function properly (underactive)

Genetics

• ~1/3 of variability in anxiety disorders is due to genetics

• Genetic predisposition is non-specific to diagnosis

Temperament: Behavioral Inhibition System (BIS)

• BIS activated when threat is perceived

• Helps us to avoid exposure to punishment and danger

• Overactive BIS: excessive fear, hyperarousal, negative emotionality

• Anxiety disorders associated when overactive fear circuitry in the brain

Behavioral Perspective: Learning to be Anxious

Two-factor theory

• Classical conditioning: we learn to have a fear response of situations, associating fear with something

  • Example: little Albert

• Escape conditioning: when were afraid our natural response is to escape

• Vicarious acquisition

• Verbal transmission of information

Mood and Anxiety Tracking

• Shift from being a passive victim to being an observer of your anxiety

• Identify anxiety triggers

• More accurate record, including times when you were not anxious

• Evaluate progress

Cognitive Restructuring

• Collaborate empiricism

• Treat anxiety-provoking thoughts as hypotheses

  • Look for evidence

  • Explore alternative helpful, realistic thoughts

• Take credit for successes, cope with disappointments

Exposure Therapy

• Cognitively-behaviorally oriented treatment approach

• Involves the patient approaching and engaging with anxiety- or fear-provoking stimuli that objectively pose no more than everyday risk

• Do not escape from the situation or use anxiety-reduction “coping” skills

• Clients have an experience that contradicts their expectations

• In vivo

• Imaginal

• Virtual reality