Anxiety: GAD: 5.2: A, B, C

GAD, Statistics, Causes

why GAD is diff from other anxiety disorders,
and considered first

Generalized anxiety disorder is deals with anxiety about events in everyday life

while others have a main focus
(social anxiety, phobia, separation anxiety)

Generalized Anxiety Disorder

Uncontrollable, and constant worrying, about things indiscriminately, and unproductively
includes tenseness, irritability, restlessness

how long do you need to have anxiety to qualify for disorder (DSM 5 - tr)

6 months, more days than not

The worry process regular vs in GAD

normally when we have a worry, when the event causing us worry is over, the worrying it stops.
But in anxiety the worrying continues, they just find a new worrying event

Apprehensive expectation

excessive anxiety and worry

Diagnostic Criteria for GAD: (AB)

A. Apprehensive expectation over a number of events of activities for 6 months on and off

B. Worrying is uncontrollable

Diagnostic Criteria for GAD: (C)

RBD IMS

(r bdays in my sex)

C. Has 3 or more of following symptoms (over 6 months more days than not)

(only 1 needed for children)

1. Restlessness

2. Being easily fatigued

3. Difficulty Concentrating

4. Irritability

5. Muscle tension

6. Sleep disturbance

Diagnostic Criteria for GAD: (DEF)

D. Clinical Impairment, Distress in life: work/social

E. Not due to a substance or medical condition

F. Not better explained by another disorder

Does GAD physical symptoms differ from panic disorders

yes GAD has different physical symptoms from panic disorder (somewhat)

Panic related to Sympathethic NS of ANS

and GAD has issues with tension, fatigue, concentration, sleeping

how many Canadians have GAD

3% but 9% qualify at some point during their lifetime

GAD and depressive episode correlation

Half of Canadians with GAD have symptoms of major depressive episode

Do people with GAD go more to therapy or dr

most go to doctor rather than therapy (prob due to physical symptoms).

those with panic disorder though go to therapy more for treatment

GAD most prevalent in which gender and age group

2/3 of people with GAD are women and girls (Canada, South Africa was opposite)

and is prevalent in older adults (US study 45yr old women)

GAD onset

not consistent, and comes in gradually. stress life events play a role. some get it late adolescence, some late in life, some in early adulthood.

more research needs to be done

Happens earlier overall compared to other anxiety disorders

GAD Recovery

often when it starts it is chronic,

only 8% become symptom free after 2 years

symptoms stay more consistently over time compared to panic disorder

Benzodiazepine

tranquilizing drug, reduces anxiety, and CNS acitivty, insomnia etc.

inferes with cognitive funciton and motor function

(makes alertness difficultat school or work)
(elderly people fall)

causes dependence on the drug

GAD Prevelance in US vs Canadian age groups

GAD was found more prev in older adults in US study

Canadian study found it more prev in adolescents/young adults.

however, elderly people are prescribed more benzodiazepine so this is possibly skewing results

GAD causes: genetic 

and studies involved

there is a genetic contribution for the tendency to become anxious

identical twin study showed if one twin had GAD so did other 

but more research showed the tendency for anxiety is genetic not the disorder itself

Anxiety sensitivity

becoming distressed over arousal reaction/sensations

this is the one heritable trait for anxiety

GAD is physically different from other anxiety disorders

GAD are less responsive on arousing physical factors (heart rate, BP, skin conductance)

What is the one physical symptom those with GAD have that distinguishes them

muscle tension is far worse for those with GAD compared to normal people

GAD model by Dugas, Ladoceur
(IPPC)

1. Intolerance of uncertainty

2. Positive beliefs about worry

3. Poor problem orientation

4. Cognitive avoidance

Intolerance of uncertaintiy

those with GAD cannot handle uncertainity compared those with other anxiety disorders

Positive beliefs about worry

Those with GAD believe worrying is necessary to prevent negative outcomes

Poor Problem Orientation

people with GAD avoid their problems, find them threatening, instead of taking them on

Cognitive avoidance

worrying is a mechanism used to avoid. since they’re too focused on analyzing future problems, they have no more attention span to visualize the threatening outcome. so their worrying prevents an arousal response.

so by worrying, they never face their problems. get muscle tension, ANS inflexibility. don’t adapt

Do people with GAD inherit the ability to be tense

yes they inherit the ability to be tense

How do people with GAD respond to stress

they become apphrensive, and cautious, vigilant.

this sets off chronic worrying which prevents ANS response

What did checking for GAD during COVID 19 reveal

that people are more likely to get GAD symptoms when going through stressful life events

What are the treatments of GAD

drugs and psychological

benzodiazepine give short-term relief (w/ risk)

Therapy short and long term relief

antidepressants (paroxetine, venlafaxine) work better than benzodiazepine

how does psychological treatment for GAD work ? (combating cognitive avoidance)

they counteract that avoidance tendency, and help them process threatening information

using images that will make them feel anxious (rather than avoiding it)

how does psychological treatment for GAD work ? (combating tension)

patients are taught how to relax deeply to relieve muscle tension

CBT for GAD

developed in the 90s, has paitent show worries, and then they confront threatening thoughts and images

effective as shown by study comparing treatments: CBT, yoga, and stress education. CBT and yoga worked, but CBT’s improvements remained for 6 months after, 75% successful

GAD psychological treatment following the cognitive model by Ladoucuer

Ladocouceur invented a treatment that followed the cognitive model. 
(ex. to fix positive attitudes toward worry, they had patient examine its actual usefullness)

Treating uncertainty to treat GAD

Dugas found all that may be needed to treat GAD is getting the patient to tolerate their uncertainty

Mindfullness to treat GAD

the highest success rates for treating GAD came from a study which used mindfulness (accepting the distressing thoughts) plus cognitive therapy

Sertraline to treat GAD

placebo study with 7-17 yr olds showed sertraline and CBT are almost immediately effective,

but there’s an even higher success rate when combined with CBT 80% improved