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GENERALIZED ANXIETY DISORDER (CHARACTERISTIC FEATURES (Excessive worry…
GENERALIZED ANXIETY DISORDER
CHARACTERISTIC FEATURES
Excessive worry
about a variety of topics
Future-oriented
(depression is more past-oriented)
Perceived
inability to control
worry
Chronic & relapsing
in course
Gradual development
, often beginning in childhood/adolescence
Physical anxiety symptoms
- rapid heartbeat, heavy breathing, sighing, tightness in chest, sweating, headaches, GI problems etc
Once considered minor disorder, now well-established as
highly debilitating disorder
similar to MDD
EPIDEMIOLOGY & PROGNOSIS
onset in childhood/adolescence (the earlier the onset, the poorer the prognosis)
lifetime
prevalence -
5% of Canadians
1-year
prevalence -
3% of Canadians
women 2x as likely
80%
have comorbid
mood/anxiety
disorder (e.g., SAD, PD, MDD)
25-35%
have comorbid alcohol/substance use disorder
18-38%
achieve full remission of symptoms
higher rates of disability in women than men
THE METACOGNITIVE MODEL OF GAD
Trigger
(real/hypothetical problem)
Positive meta-beliefs activated
(strategy selection) - attribute success to worry
Type 1 Worry
- problem at hand; triggered by everyday events
Negative meta-beliefs activated
- worry doesn't seem to be beneficial any more (e.g., running out of time, people saying to stop worrying)
Type 2 Worry
(meta-worry) - "worry about worry"
Leads to
behaviours, thoughts, emotions
- emotions feed back into Type 1 Worry
Evidence
found that worry-induction leads to increase in -ve thought intrusions, but GAD patients have significantly greater -ve intrusions than control group, much more distressed, less able to control -ve thoughts
GAD has immediate reaction to worry
those with GAD, despite actual cognitive abilities, are less confident in cognitive abilities, unable to control own thinking processes generally, not just related to worry
catastrophize
self-aware of contents of own thoughts
WORRY AS AN AVOIDANCE STRATEGY
purpose of worry is to shield individual from
fully experiencing
fear &/or negative emotion
abstract in content, not evoking visual imagery or emotional processing; in contrast to fear, which is more concrete & visual in nature & more likely to evoke strong emotional response
Contrast Avoidance
- people with GAD chronically worry so that they do not feel a sharp spike of negative feeling if they happen to experience feared outcome (prepare for worst)
constantly at heightened emotional state
ETIOLOGY & ASSOCIATED FACTORS
BIOLOGICAL
disturbances in neurotransmission, leading to reduced downregulation of threat-sensitive brain structures & increased anxiety (decreased GABA activity
↑ HPA-axis activity → ↑ release of stress hormones (e.g., cortisol, esp. in older adults)
disrupted connectivity between emotion & threat processing regions (larger amygdala, PFC less efficient at inhibiting amygdala)
rigid ANS activity
ENVIRONMENTAL
exposure to stressful life events (alters HPA-axis activity in response to stress)
being raised in negative/rejecting home env't (constantly hearing -ve evaluations from parents, so plan for scenarios to avoid)
insecure parental attachment
PSYCHOLOGICAL
dysfunctional attitudes about own problem-solving ability
probability overestimation
- thinking something feared is more likely than it is
catastrophizing
- feared outcome much less manageable (or more severe) than it is
biased attention
to threatening stimuli
interpretation of ambiguous stimuli as threatening
intolerance of uncertainty
elevated trait anxiety & perfectionism
impaired attention & memory during states of high anxiety
TREATMENT
PSYCHOLOGICAL INTERVENTIONS
CBT for GAD
psychoeducation
about GAD, worry & anxiety
progressive muscle relaxation
&
breathing techniques
monitoring of
env'tal triggers
for worry, increasing
awareness
of behaviour & bodily sensations in response to worry
in vivo exposure
to feared situations
cognitive restructuring
to challenge fearful thoughts & develop realistic expectations
targets intolerance of uncertainty
often best choice
Metacognitive Therapy for GAD
targets -ve beliefs about danger & uncontrollability of worry
targets +ve beliefs about advantages of worry
BIOLOGICAL INTERVENTIONS
benzodiazepines - reduces physical symptoms, worry, tension, & improves concentration
SSRIs - targets serotonin reuptake to increase serotonin neurotransmission (low levels of serotonin is associated with high levels of anxiety)