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GAD (Theory (More freeze than fight or flight (Canon, 1932), Person is not…
GAD
Theory
More freeze than fight or flight (Canon, 1932)
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Lost in illusions of the future and past (Borkovec, 2012)
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Stepped care model
Step 1 - All known and suspected presentations of GAD
- Identification and assessment: education about GAD and treatment options - active monitoring
Step 2 - Diagnosed GAD that has not improved after education and active monitoring in primary care
- Low intensity psychological intervention: individual guided self-help and psychoed groups
Step 3 - GAD with an inadequate response to step 2 intervention or marked functional impairment
- High intensity intervention or drug treatment
Step 4 - Complex treatment - refractory GAD and very marked functional impairment such as self-neglect or a high risk of self harm
- Highly specialised treatment, such as complex drug and/or psychological treatment regimes; input from multi-agency teams, crisis service , hospital or inpatient care
ABC model
Autonomic (physical sensations)
- Sweating
- Disturbed sleep
- Tension
- Headaches
- Tired
Behaviour
- Worry
- Reassurance seeking
- Procrastination
Cognition's (thoughts)
- What if something bad happens
- If I do not worry then things will go wrong
DSM-V
- Excessive anxiety and worry about 2 or more domains of activities/events (e.g family, health, finances etc)
- Occurring on more days than not for 6 months or more.
At least of 3 of the following:
- Restless, on edge
- Muscle tension
- Easily fatigued
- Difficulty concentrating
- Irritability
- Sleep disturbance
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The facts
- 4.4% of people in England have GAD (McManus et al, 2009)
- Twice as common in women than men (Remes et al, 2016)
- Risk is 5 times more higher if first degree relative has GAD (Noyes et al, 1987)
- Over 50%co-morbidity with depression (Dugas & Robichaud, 2007)
- Most report early onset, 30 - 40% report an onset in later life (Le Roux ey al, 2005)
Associated behaviours
Borkovec (1995) recommend the following to improve reliable diagnosis:
Anxiety and worry are associated with 1 or more of ...
- Marked avoidance of activities or events with possible negative outcomes
- Marked time and effort preparing for activities or events with possible negative outcomes
- Marked procrastination in behaviours or decision making due to worries
- Repeatedly seeking reassurance due to worries.