Flashcards in 7 Anxiety 3 – GAD Deck (41):
When was Generalised Anxiety Disorder (GAD) first introduced into DSM?
Into DSM-III-R (1980)
What are the four criteria for GAD?
1. Excessive, uncontrollable worry about a variety of events/outcomes
2. Occurs more days than not
3. For at least 6 months
4. At least 3 of 6 somatic symptoms
- difficulty concentrating
- muscle tension
- sleep disturbance
What physiological aspect differentiates GAD from other anxiety disorders?
It's the only anxiety disorder not strongly associated with autonomic arousal.
Is GAD just excessive worry?
No, it must also be uncontrollable, as this suggests a different dysfunction. Compare difference between 1) eating lots because you like food and 2) not being able to control eating.
What kind of threat perception is typical of older adults/young people?
Older adults generally worry about physical/health threats
Younger adults generally worry about social threat
Do people with GAD worry about different things from normal worriers?
No, they just worry more and about more things.
What are 4 perceived positive aspects of worrying?
1. Motivates action
2. Helps to problem solve
3. Helps avoid negative outcomes
4. Distracts from more distressing topics (perhaps typical of GAD)
In what three ways is worry most commonly managed in normals?
1. Problem-solve the situation
2. Distract yourself
3. Seek social support
Can GAD be explained by biased threat perception?
Not entirely. Sure, people with GAD have biased threat perception, but this DOESN'T explain why they worry obsessively rather than having a panic attack or cleaning house, cutting themselves etc.
How can GAD be explained through problem-solving theory?
GAD sufferers can't exit worry via problem solving because each solution solicits new threat perceptions. E.g. 'Worried about exam, if I study more won't see friends, they'll hate me.'
What are the 4 stages of D'Zurilla and Maydeu-Olivares (1995) theory of Social Problem Solving?
1. Problem definition
2. Generation of alternative solutions
3. Solution evaluation positive/negative
4. Solution selection
Which stages of Social Problem Solving go wrong in GAD?
3. Solution evaluation positive/negative – see new threats in every solution
4. Solution selection – all solutions seem fraught with risk
How can it be argued that GAD is dysfunctional?
Main function of worry is to avoid negative consequences. GADders create a negative consequence for themselves.
How does Borkovec's cognitive avoidance theory explain GAD?
People with GAD worry – a verbal mental activity – to avoid visual imagery, which is more arousing and more aversive.
Is worrying more verbal or image-based?
Verbal. When people switch from relaxation to worry, verbal centres light up. We tend to worry in words.
What is more aversive, according to Berkovec, images of a possible negative event or worry about the event?
Images – they cause more anxiety symptoms than worry, which is largely verbal.
How can cognitive avoidance maintain worry, selon Berkovec?
Cognitive avoidance (of imagery) interferes with emotional processing of that imagery. Can't habituate to image, which reduces fear of it. No reduction of cost.
GAD is more associated with __________ tension than with ___________ arousal.
GAD is more associated with muscle tension than with autonomic arousal.
Why do some people want to avoid autonomic arousal/anxiety more than others?
Because of individual differences in ability to tolerate autonomic arousal.
What kind of sensitivity is GAD associated with?
With anxiety sensitivity – GAD sufferers dislike sensations of anxiety more than normals.
Like people with eating disorders, GAD sufferers have high ____________, but instead of binging, say, they worry.
Like people with eating disorders, GAD sufferers have high distress-intolerance, but instead of binging, say, they worry.
According to avoidance theory, people with GAD worry because it feels better than feeling ____________.
According to avoidance theory, people with GAD worry because it feels better than feeling anxious.
According to Hayes et al. (1996) GAD sufferers avoid not only anxiety, but also?
Any internal experiences. Try to reduce feeling anything – positive or negative. ‘As soon as I feel good, something bad must be about to happen!’
GAD sufferers have problems with regulation (identification, tolerance, modulation) of what?
When they can't regulate the emotions elicited by a perceived future threat, what do GAD sufferers do?
Worry about it
According to Ladouceur et al. (2000) GAD sufferers are intolerant of what?
What beliefs about uncertainty might drive GAD?
- Uncertainty reflects badly on a person
- Uncertainty causes frustration and stress
- Uncertainty prevents action
How much uncertainty can GAD sufferers handle?
Zero – they try to reduce it to an unreasonably low limit
Intolerance of uncertainty leads to a preoccupation with _________ and interferes with ______________
Intolerance of uncertainty leads to a preoccupation with details and interferes with problem-solving
What is Wells' (1995) disctinction between Type 1 and Type 2 worry?
Type 1 is normal worry – worry about perceived threat
Type 2 is metaworry – worry about worry
What is the difference in beliefs about worry between Type 1 and Type 2 worriers?
Type 1 (normal worriers) have positive beliefs about worry – they think it's useful
Type 2 (metaworriers) have negative beliefs about worry – they think it's to be avoided
What causes metaworry to spiral?
Ineffective thought control strategies – e.g. suppression, self-directed anger – make it difficult to leave worry process, thus amplifying metaworry.
What does the diversity of theories about GAD suggest?
That we don't really know what causes and maintains it.
How can GAD be treated by modifying biased threat perception?
Must be a general approach – can’t attack worries one by one. Attack general tendency to overestimate threat.
How can GAD be treated by modifying problem-solving strategies?
Through problem-solving training. GAD sufferers need to learn how to come up with positive solution evaluations – not just negatives… ‘buts’
How can GAD be treated by reducing avoidance of images of a feared event?
Exposure. If GAD sufferers are worrying to avoid anxiety induced by imagery, then need to do exposure to whatever it is these people are avoiding. If worry about failing the exam, picture what will happen if it does happen?
How can GAD be treated by reducing avoidance of emotional experience?
Exposure. If avoiding emotional experience, must expose client to distress – I’m anxious and I can just sit with it, don’t have to avoid it.
How can GAD be treated by reducing avoidance of uncertainty?
Exposure to uncertainty – I’ve done everything I could, and I have to put up with the idea that this bad thing might happen.
How can worry be treated according to metacognitive theory?
By challenging the beliefs about worry.
In Type 1 worry, change positive belief that worry is helpful helpful.
In Type 2 worry, challenge the negative belief that worry is bad.
What third-wave treatments appear effective for GAD?
Mindfulness and interpersonal therapy