problem 6 - generalized anxiety disorder Flashcards
what is the core symptom in GAD
Excessive worry - duration requirement of 6 months
Worry = a perseverative neg cognition where undesirable outcomes are expected
pathological worry: excessive, for no reason, uncontrollable, chronic, disproportionate
GAD and non-GAD worriers are differentiated by severity of distress, impairment, and uncontrollability of worry, rather than qualitative differences
negative valence system in GAD
worry increases neg emotions and decreased pos emotions
* worry also increases anxiety & depression
* effects of worry on neg emotionality are prolonged in GAD
* amygdala: regulates a rapid-onset, short-duration reaction to threats - FEAR
* BNST: involved in a more persistent stress response to sustained threats - ANXIETY
neg valence system
why do individuals with GAD worry excessively despite its emotional costs?
avoidance model: worry serves as a maladaptive strategy to avoid neg internal experiences
- verbal nature of worry inhibits imagery of a fear-provoking stimulus + dampens the initial physiological reaction to the fear stimulus
contrast-avoidance model: proposes that instead of precluding negative emotions, worry creates and sustains them to prevent a further sharp increase in negative emotions
cognitive systems in GAD
Worry itself is a cog process focusing on threatening future outcomes - cog models of worry explain the nature of GAD by relying on:
1. Attentional bias
2. Negative interpretations of stimuli (interpretation bias)
3. A lessened ability to control cognition to detach from worry and threat
4. Worry’s interference with cognitive abilities (such as memory)
5. Disorder maintaining beliefs
cognitive control & GAD
**Cognitive control: **a variety of processes responsible for directing attention & guiding goal-directed activity - task shifting, inhibition & WM
- Worry depletes attentional control ability and working memory
Shifting: GAD exhibit difficulties with shifting between sets of info - may lead to the perseverative quality of worry
Inhibition: may also be diminished in GAD
Working memory: deficits in GAD
beliefs about worry in GAD
pos beliefs: tend to believe worry is useful & percieve to have many useful functions (e.g. faciliate prob solving & prepare for challenges)
neg beliefs: worry is uncontrollable & dangerous → worry about their worrying
- come to believe they cannot control their minds or lives
positive valence systems in GAD
- are responsible for reactions to pos motivational stimuli, situations & contexts
- possibility that those with GAD are under-responsive to pos factors (is somewhat neglected)
- GAD less likely to allow themselves to dwell on pos feelings for long, because this increases the probability that if something neg occurs, they will experience an undesirable neg emotional contrast
arousal/regulatory systems in GAD
- People with GAD have a higher arousal on average basically all the time
- low heart rate variablity
- Sleeping difficulties – difficulties of sleep maintenance rather than sleep initiation
interpersonal dysfunction in GAD
- is one of the most common worry themes
- Interpersonal problems affected treatment outcomes and maintenance of symptoms
- Insecure attachment as a risk factor for GAD → representations of the world as a threatening place and the self as inept at eliciting help/love
treatments for GAD
metacognitive therapy
focuses on modification of patient’s belief about worry (e.g. neg beliefs about uncontrollability of worry)
process:
1. neg beliefs about worrying are targeted
2. pos beliefs concerning the usefulness of worrying are addressed
3. alternative strategies for processing threatening triggers are explored (e.g. letting go of thoughts instead of trying to deal with them)
treatments for GAD
intolerance-of-uncertainty therapy
focuses on decreasing anxiety and the tendency to worry by helping patients develop the ability to tolerate, cope with, and even accept uncertainty in their everyday lives
process:
1. worry awareness training - a distinction between worries that are amenable to problem solving & worries that are not
2. problem-solving training for worries about soluble problems - consists of 5
3. pos beliefs about worry are directly modified by cognitive therapeutic interventions
treatments for GAD
MCT vs IUT
both are effective treatments for GAD - both treatments produced sig decreases in GAD symptoms (i.e., worry, trait anxiety)
BUT
in general, MCT produced better results than IUT at both the posttreatment and the follow-up assessment
