GAD and death anxiety

Question 1

Anxiety disorders

Answer 1

Perceived threat activates anxiety in 3 domains:
- Physical
- Cognitive
- Behavioral

Characterized by over estimation of threat (cost or probability of harm)
- Reflect an internal dysfunction
- Situations are not objectively dangerous
- Deviant, dysfunctional, distressing

Question 2

Describe DSM-5 GAD

Describe the 4 components in the emotional dysregulation model of GAD

Answer 2

A. Generalized anxiety disorder
- Excessive anxiety and worry, more days than not for at least 6 months, about a number of events or activities
B. The individual finds it difficult to control the worry
C. Anxiety and worry are associated with at least 3 of the following:
- Edginess/restlessness
- Irritability
- Chronic fatigue
- Difficulty sleeping/concentrating
- Muscle tension
D. Causes clinically significant distress or impairment in social or occupational areas of functioning
E. Not attributable to another medical condition
F. Symptoms are not better explained by another mental health condition

Emotional dysregulation model of GAD
1. Greater intensity of emotions
2. Poorer understanding of emotions
3. More negative views on emotions
4. Poorer emotional regulation strategies

Question 3

Define what “normal” worry is

Answer 3

Occurs in response to perceived future threat (social or physical)
Contains more verbal thought than imagery

Perceived positives: motivates actions, keeps one safe for harm, helps problem solve
Perceived negatives: uncontrollable, belief it can lead to mental or physical harm

Question 4

What is the Avoidance model (Borkovec, 1994)

Describe the Intolerance of Uncertainty (IU) Model

Describe the metacognitive model (MCM)

Answer 4

Worry contains more verbal thought than imagery
Worry -> cognitive avoidance
- Interferes with emotional processing and extinction
- Worry is negatively reinforced by removing unpleasant images

IU model
Uncertainty reflects badly on a person, causes frustration and stress, and prevents action
Worry aims to reduce uncertainty to zero
IU distinguishes GAD from (most) other anxiety disorders

Metacognitive model (MCM)
Type 1 worry:
- Faced with anxiety-provoking situation/perceived threat
- Positive beliefs about worry
- Possible exit by problem solving or reassurance

+ Negative beliefs about worry

Type 2 worry:
- “Meta-worry”
- Ineffective thought-control strategies
- Increased anxiety and worry

Question 5

What is the Avoidance model (Borkovec, 1994)

Answer 5

Worry contains more verbal thought than imagery
Worry -> cognitive avoidance
- Interferes with emotional processing and extinction
- Worry is negatively reinforced by removing unpleasant images

Question 6

Treatment for GAD

Answer 6

Theoretical approach
Biased threat perception:
- probability and cost judgements
Avoidance model:
- exposure to vivid images of feared event
- Exposure to anxiety/distress
Emotional dysregulation Model:
- emotional education
- emotional regulation training
- experiential exposure exercises
- exposure to uncertainty
- Challenge positive and negative beliefs about worry

Treatment components
- Record worrying thoughts (including meta-worry)
- Focus on beliefs about worry, rather than content
Behavioral experiments:
- pink elephant
- To address positive beliefs: worry vs not worrying
- To target negative beliefs: controlled worry periods

Question 7

What is a transdiagnostic construct?

Answer 7

Disorders share many core features
Transdiagnostic process or constructs feature across several disorders and represent a causal mechanism across several disorders
Why?
- High comorbidity
- Transdiagnostic treatments

Question 8

What is Death anxiety?

What is terror management theory (TMT)?

Answer 8

• Death is a central part of human condition which has been recorded throughout history
  Themes of death pervade:
• Literature, Art, Theatre
• Religion, Ritual, Myth
• Philosophy

The denial of death (Becker, 1973)
- Motivation to live + inevitability of death = crippling fear

TMT are the two main buffers against death anxiety
1. Cultural worldviews
- Gain virtual immorality by buying into beliefs
2. Self-esteem
- Gain meaning by fulfilling expectations of cultural worldview

Death anxiety explains much of human behavior
- 200+ mortality salience studies (spider phobias, social anxiety, eating disorders, OCD, Panic disorder & illness anxiety disorder
- What about abnormal behavior?
- Death anxiety might be a transdiagnostic construct (revolving door of mental health)

Implications?
- Recent research suggests we may need to rethink treatment of these conditions

What do treatments for anxiety look like?
- CBT = largest improvements
- Exposure therapy