GAD Flashcards
GAD: Brief History of DSM Diagnosis
1980 -‐ DSM-‐III -‐ “residual” disorder characterized by hyper-‐arousal
1987 -‐ DSM-‐III-‐R -‐ primary disorder
major revision: worry is central component
1994 -‐ DSM-‐IV -‐ minor revisions remains primary disorder
worry remains as cardinal feature
2013 – DSM-‐5
worry remains cardinal feature
- 3 mos duration from 6 mos
- addition of changes in behavior as a result of the worry
DSM-5 Checklist
Generalized Anxiety Disorder:
- Excessive or ongoing anxiety and worry, for at least 3 months, concerning two or more activities or events
- Restlessness And/or Muscle Tension
- Behavior May Be Affected by Anxiety or Worry
- Significant Distress or Impairment
Worry vs Anticipatory Anxiety vs Fear
Worry – focus on POTENTIAL future threat
Anticipatory Anxiety – focus on future threat
Fear – imminent threat
Pathological worry vs Normal worry
Frequency, intensity, duration of worry
- excessive
- unrealistic
Individual’s ability to control the worry
Functional impairment as a result of worry
Differential Diagnosis
Worry is a common feature of almost all anxiety disorders (e.g. social phobia, panic) as well as other disorders (e.g. hypochondriasis)
GAD dx:
Worry cannot be confined to features of another disorder
*e.g. worry about having a panic attack; worry about social situation, worry about contamination
GAD Comorbidity
93% of patients with GHD are diagnosed with at least one additional disorder
46% comorbid with major depression or dysthymia
*Estimates of 50% of alcohol abusers have prior dx of GAD
GAD prevalence
3.1% of US population (6.8 million individuals)
10% – sub-threshold GAD
“worriers”
Worry Functionality
Worry is an attempt at problem solving
Given the prevalence of worry, something so widespread must of had an adaptive function
*without worry, unable to anticipate potential negative events
Information Processing Model of Anxiety
Anxiety =
Appraisal of risk/danger
+
Appraisal of coping with the risk/danger
Psychopathology of GAD
Increased risk perception
Decreased coping ability
Increased risk perception
Information processing is driven by a core sense (schema) of vulnerability
Vulnerability leads to over estimation of risk
*both probability and severity
Decreased Coping Ability
Problem-solving is impaired, overrun by anxiety
Replaced by cognitive avoidance and safety seeking behaviors
Thus – perception of coping ability is decreased
GAD as Personality Disorder
- Lifelong and chronic history of anxiety with no clear onset, or onset stemming from childhood or adolescence
- Generalized anxiety (worry) is a very common feature of normal behavior
* it is a basic psychological dimension that is present in everyone to some degree
Treatment Implications of GAD as Personality Disorder
More chronic may mean more treatment required
Ego-syntonic – is there a motivation to change?
GAD evidence-based interventions
Cognitive Restructuring
Worry Exposure
Stimulus – Control Procedures
Problem-Solving Training
Relaxation Training
ERP Of Behavioral Component
GAD assessment
Clinical interview
Penn State Worry Questionnaire
M = 68 SD = 9
BAI: anxious arousal
CBT for GAD
Psychoeducation
Strategies to address the following components:
Cognitive
Physiological/Somatic
Behavioral
Existential component
Need to develop tolerance/acceptance of risk/uncertainty
Manage risks rather than eliminate
Anxiety the shadow of intelligence? The specter of death”
GAD Psychoeducation
- The function of worry
- The 4 systems/components of anxiety:
* affect
* physiology
* cognition
* behavior - When is it a disorder? – Normal versus pathological worry
- Rationale of CBT treatment, components:
Cognitive
Physiological
Behavioral - Discuss role of homework and monitoring of triggers for emotional reactions (thought record)
Rationale of CBT treatment: Cognitive Component
Cognitive Restructuring–logical analysis
Stimulus control – Scheduling “worry time”
Worry exposure – processing and habituation
Problem-solving training – increase coping skills
Rationale of CBT treatment: Physiological Component
Progressive Muscle Relaxation (PMR)
Rationale: decrease hyperarousal
In Session: practice skills to make sure patient is implying skill properly
HW: Twice daily – Approximate 15 Minutes
Homework
Explains that homework will become an integral part of treatment
To increase compliance:
Set time/day in session, give “prescription” patient
Audiotaped instructional sessions
Use a monitoring form
- triggers for emotional reactions
- thoughts and symptoms (thought record)
Ask patient call in or email and report results
Therapist follow-up session – problem solved noncompliance
*Never think of the patient as “resistant”
Rationale of CBT treatment: Cognitive Component
Basic cognitive model: appraisal theory
Cognitive Restructuring
- identify distorted, exaggerated thoughts that stem from the enhanced sense of vulnerability
- have patient deliberately modify these anxious appraisals (create cognitive flexibility)
The Nature of Cognition (Information Processing):
- Confirmatory Bias
- Mood Congruent Processing
Cognitive Themes in GAD
Stem from a core sense of
- Vulnerability
- Lack of control (helplessness)
