Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications

Question 1

This paper critiques five contemporary models of generalized anxiety disorder (GAD), emphasizing ….

Answer 1

avoidance of internal affective experiences.

Question 2

wat was GAD vroeger voor diagnose en wanneer geïntroduceerd

Answer 2

GAD was first introduced as a diagnosis in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), but was most often used as a residual diagnosis for individuals who did not meet diagnostic criteria for another anxiety disorder.

Question 3

wat zijn de 5 modellen

Answer 3

• avoidance model of worry and GAD (AMW)
• the intolerance of uncertainty model (IUM)
• the metacognitive model (MCM)
• the emotion dysregulation model (EDM)
• acceptance-based model of generalized anxiety disorder (ABM)

Question 4

wat is het idee van the avoidance model of worry and GAD

Answer 4

worry is a verbal linguistic, thought-based activity that inhibits vivid mental imagery and associated somatic and emotional activation, which inhibits the emotional processing of fear that is theoretically needed for successful habituation and extinction. also positive worry beliefs and attachment styles reinforce this verbal-linguistic worry

Question 5

wat voor factoren hebben nog meer invloed hierop volgens avoidance model of worry and GAD

Answer 5

• Poor interpersonal skills
• past trauma
• insecure attachment styles (perceive the world as a dangerous place)

Question 6

wat voor empirical support voor avoidance model of worry and GAD

Answer 6

Evidence suggests worry is primarily verbal-linguistic, individuals with GAD require a longer period of time to return to baseline following a stressor (= prolonged hyporesponsiveness), and that individuals with GAD have an increased prevalence of insecure attachment styles, leading to increased interpersonal difficulties.

Question 7

dus wat is in een paar woorden het avoidance model of worry and GAD

Answer 7

worry = verbal, thought based
fear = vivid mental imagery, somatic & emotional experience

worry prevents fear, which is needed for habituation and extinction

Question 8

worry can be seen as an ineffective cognitive attempt to problem solve and thus remove a perceived threat, while simultaneously avoiding the aversive somatic and emotional experiences that would naturally occur during the process of fear confrontation

Answer 8

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Question 9

According to the AMW, catastrophic mental images that make their way into the worry process are replaced by less distressing, less somatically activating verbal linguistic activity.
Thus, worry is negatively reinforced by the removal of aversive and fearful images

Answer 9

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Question 10

6 theoretical components of AMW

Answer 10

• cognitive avoidance
• positive worry beliefs
• ineffective problem solving/emotional processing
• interpersonal issues
• attachment style
• previous trauma

Question 11

key interventions of avoidance model of worry and GAD

Answer 11

• self monitoring
• relaxation
• cognitive restructuring
• self-control desentitization
• gradual stimulus control
• worry outcome monitoring
• present-moment focus
• expectancy free living

Question 12

self-monitoring =

Answer 12

of external situations, thoughts, feelings, physiological reactions, and behaviors

Question 13

relaxation techniques such as ….

Answer 13

progressive muscle relaxation, diaphragmatic breathing, and pleasant relaxing imagery

Question 14

self-control desensitization=

Answer 14

the use of methods (e.g., imaginal rehearsal) to facilitate the acquisition of habitual coping responses

Question 15

gradual stimulus control =

Answer 15

achieved by establishing a specific time and place for worrying

Question 16

cognitive restructuring =

Answer 16

aimed at increasing clients’ flexibility in thinking and access to multiple, flexible perspectives

Question 17

worry outcome
monitoring =

Answer 17

clients keep regular diary entries in order
to monitor specific worries, their feared outcomes, and the actual outcomes of those worries;

Question 18

Intolerance of uncertainty model (IUM)=

Answer 18

• ppl with GAD find uncertain/ambiguous situations stressful
• believe that worry will prevent events, or help them cope with them
• worry + anxiety lead to negative problem orientation and cognitive avoidance
• maintains the worry

Question 19

wat zijn 3 kenmerken van individuals met GAD volgens intolerance of uncertainty model

Answer 19

1. lack in confidence in problem solving ability
2. perceive problems as threat
3. easily frustrated when dealing with problem
4. pessimistic about the outcome of problem solving efforts

Question 20

wat is evidence for this model

Answer 20

• intolerance of uncertainty lijkt specifiek te zijn voor GAD
• increasing intolerance of uncertainty lijkt tot meer worry te lijken
• improvements in IU may be a key mediator for reducing worry

Question 21

intolerance of uncertainty model theoretical components

Answer 21

• intolerance of uncertainty
• negative problem orientation
• cognitive avoidance
• beliefs about worry

Question 22

key interventions voor intolerance of uncertainty model

Answer 22

• self-monitoring
• intolerance of uncertainty education
• evaluating worry beliefs
• improving problem-orientation
• processing core fears

Question 23

the metacognitive model (MCM)

Answer 23

• ppl have 2 types of worry
• type 1 worrying is normal worrying
• during type 1 worry: negative beliefs about worrying are activated
• individuals with GAD start to worry about their type 1 worrying
• they fear that the worry is uncontrollable and may even be dangerous
• this is type 2 worrying

Question 24

type 1 worry in metacognitive model =

Answer 24

type 1 worry is when individuals are faced with an anxiety-provoking situation, worry about non-cognitive events

Question 25

type 2 worry in metacognitive model =

Answer 25

worry about worry, meta-worry, fearing that their worry is uncontrollable or even dangerous

Question 26

wat is het verschil met ‘normaal’ worrying, in het metacognitive model

Answer 26

• negative beliefs
• type 2 worrying

Question 27

waar leidt type 2 worrying weer toe

Answer 27

Type 2 worry is hypothesized to be associated with a host of ineffective strategies that are aimed at avoiding worry via attempts at controlling behaviors, thoughts, and/or emotions (e.g., reassurance-seeking, checking behavior, thought suppression, distraction, and avoidance of worrisome situations)

Question 28

MCM: Furthermore, the very efforts used by those with GAD to control their thoughts (e.g., thought suppression, distraction) are often unsuccessful. As a result, they may lose confidence in their ability to control their worry, ultimately serving to reinforce the belief that worrying is uncontrollable and dangerous.

Answer 28

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Question 29

Finally, Type 2 worry leads to an increase in anxiety symptoms, which may then serve a
maintenance function if individuals interpret these anxiety symptoms as signs that their worrying is dangerous or uncontrollable

Answer 29

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Question 30

metacognitive model empirical support

Answer 30

Studies of the Metacognitive Model of Worry (MCM) suggest that individuals with Generalized Anxiety Disorder (GAD) endorse negative beliefs about worry and report engaging in meta-worry. However, evidence pointing to the specificity of negative beliefs about worry and meta-worry to GAD is mixed. Additionally, the temporal relationship between constructs suggested by the MCM, as well as the role of ineffective coping strategies in the perpetuation of GAD, await evaluation.
dus niet heel veel support voor deze

Question 31

The initial aim of Metacognitive Therapy (MCT) for GAD is …

Answer 31

not to reduce the amount of worry, but to alter Type 2 worry + introduce clients to alternative coping strategies

Question 32

key components of metacognitive therapy

Answer 32

• positive beliefs about worrying
• type 1 worry
  negative beliefs about worrying
• type 2 worry
• ineffective coping

Question 33

metacognitive therapy: key interventions

Answer 33

• case formulation
• socialization
• discuss uncontrollability of worrying
• discuss dangers of worry
• discuss positive worry beliefs

Question 34

alle modellen even bekijken in schrift

Answer 34

echt doen

Question 35

4 central components of the emotion dysregulation model

Answer 35

1. people with GAD experience more emotional hyperarousal (more intense emotions, both positive & negative (maar vooral negative))
2. poorer understanding of their emotions
3. more negative attitudes about emotions
4. maladaptive emotion regulation and management strategies

Question 36

bij emotion dysregulation model: hoe ga je van 1 en 2 naar 3

Answer 36

The combination of components 1 and 2 is hypothesized to lead to the third component, which stipulates that individuals with GAD become overwhelmed, anxious, or uncomfortable when strong emotions occur, thereby creating a feedback loop.

Question 37

empirical support for the emotion dysregulation model

Answer 37

Evidence suggests that individuals with Generalized Anxiety Disorder experience negative emotions more intensely and have difficulty identifying and describing their emotions, compared to healthy controls. They also fear intense emotions more and engage in more emotional coping strategies. Future studies should investigate other aspects of the Emotional Dysregulation Model, such as its temporal interactions, to further our understanding of GAD.

Question 38

wat voor treatments bij emotion dysregulation

Answer 38

op dat moment nog in development, gebaseerd op CBT en techniques that adress emotions and emotional avoidance

• relaxation exercises
• belief reframing
• emotion education
• emotional skills training
• experiential exposure exercises

Question 39

internal experiences in acceptance-based model of generalised anxiety disorder (ABM)=

Answer 39

thoughts, feelings or bodily sensations

Question 40

4 components of the acceptance-based model of GAD

Answer 40

1. internal experiences
2. a problematic relationship with internal experiences
3. experiential avoidance
4. behavioral restriction

dit wordt een soort loop, waarin de internal experiences de external (perceived) experiences een soort van overnemen

Question 41

the problematic relationship with internal experiences exists of 2 aspects:

Answer 41

1. negatively reacting to internal experiences
2. fusion of internal experiences with these negative reactions (soort snelle associatie)

Question 42

experiential avoidance in acceptance-based model =

Answer 42

actively and/or automatically avoiding internal experiences perceived to be threatening or otherwise negative.

Question 43

behavioural restriction in acceptance-based model =

Answer 43

the reduced engagement in valued actions or activities that the individual finds meaningful (e.g., spending time with family).

Question 44

‘individuals with GAD have negative reactions to their own internal experiences, and are motivated to try to avoid these experiences, which they do both behaviorally and cognitively (through repeated engagement in the worry process)’’

Answer 44

acceptance-based model

Question 45

wat zeggen ze over avoidance in het acceptance-based model

Answer 45

This avoidance reduces the distress caused
by the internal experience in the short-term. In the long-term, however, this avoidance serves to reinforce behavioral restriction
as the individual becomes less engaged in activities (either by engaging in the activities less often or by being less experientially aware during the activities) that he/she finds valuable. This results in increased distress that can trigger more negative internal experiences, thereby perpetuating the cycle.

Question 46

wel veel limitaties van ABM

Answer 46

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Question 47

key concepts of acceptance-based model of GAD

Answer 47

• internal experiences
• problematic relationship with internal experiences
• experiential avoidance
• behavioural restriction

Question 48

therapy interventions of acceptance-based model

Answer 48

• psychoeducation about ABM
• mindfullness & acceptance exercises
• behavioral change and valued actions

Question 49

the five models share a common emphasis on….

Answer 49

the avoidance of internal experiences

Question 50

Studies of GAD models have relied on self-report measures, but objective measures are needed. Experimental designs, diagnostic interviews, and RCTs with active control conditions should be used to better assess these models.

Answer 50

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Question 51

The five theoretical models of Generalized Anxiety Disorder (GAD) emphasize avoidance of internal experiences, with cognitive models focusing on cognitions, emotional/behavioral models on emotions and behaviors, and the AMW on cognitive and emotional/behavioral elements. Treatments based on these models emphasize psychoeducation, self-monitoring, and coping skills training.

Answer 51

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Question 52

Research is needed to further test existing models for Generalized Anxiety Disorder, such as cognitive, emotional/behavioral, and integrative models. Additive designs should be used to evaluate treatment components, and moderation analyses should be conducted to identify individual differences in treatment response.

Answer 52

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