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UNIVERSITY

Generalized Anxiety Disorder

Chapter I Diagnosis and Treatment of GAD
1. Clinical Appearence of GAD
2. What is worry?
3. Diagnostic Features of GAD
4. How GAD differs from other nonpathological anxiety
5. Components of GAD
6. Diagnostic Criteria
7. Prevalence
8. Comorbidty
9. Risk and Prognostic Factors
10. Clinical Evaluation
11. Treatments of GAD
12. CBT-based Models

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1. Clinical Appearence of GAD

1) Can worry about anything, turning any

issue into a worry
2) The basic mindset is "WHAT IF"

(Pearson Education Ltd., 2021; APA, 2023)

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2. What is “worry”?

- Thought charged with negative emotion, difficult to control or series of

images (similar to automatic thoughts)
- Images are not in the form of pictures, but rather conceptual and a
verbal cognitive activity
- Worrying may begin voluntarily or automatically
- Can be interrupted by intervening events
- Although its onset is relatively involuntary
Can be consciously controlled

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3. Diagnostic Features of GAD
1) For some people, worry about many different aspects of life becomes chronic, excessive,
and unreasonable
2) People suffering from GAD live in a future-oriented mood state of anxious apprehension,
chronic tension, worry, and diffuse uneasiness that they cannot control
3) The intensity, duration, or frequency of the anxiety and worry is out of proportion to the
actual likelihood or impact of the anticipated event.
Diagnostic
4) The individual finds it difficult to control the worry and to keep worrisome thoughts
Features from interfering with attention to tasks at hand.
5) Frequently engage in subtle avoidance activities like checking and procrastination

Adults with GAD often worry about everyday, routine life circumstances, such as possible
job responsibilities, health and finances, the health of family members, misfortune to their
children, or minor matters (e.g., doing household chores or being late for appointments).

Children with GAD tend to worry excessively about their competence or the quality of their
performance.

(Pearson Education Ltd., 2021; APA, 2023)

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3. How GAD differs from other nonpathological anxiety

The worries associated with GAD are excessive and

typically interfere significantly with psychosocial
functioning, whereas the worries of everyday life are not
excessive and are perceived as more manageable and may be
put off when more pressing matters arise.
Everyday worries are much less likely to be accompanied
by physical symptoms (e.g., restlessness or feeling keyed up
or on edge). Individuals with GAD report subjective
distress due to constant worry and related impairment in
social, occupational, or other important areas of functioning.

The worries associated with GAD are more pervasive,

pronounced, and distressing; have longer duration.

(Pearson Education Ltd., 2021; APA, 2023)

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4. Components of GAD
Perceptions of Uncontrollability and
Unpredictability
People with GAD may have a history of
experiencing important events in their lives as
unpredictable or uncontrollable
Also may be more likely to have had a history of
trauma in childhood
People with GAD have far less tolerance for
uncertainty
The Negative Consequences of Worry
Worrying can lead to a greater sense of danger and
anxiety
People who worry tend to subsequently have more
negative and intrusive thoughts
Attempts to control thoughts and worry may lead to
increased experiences of intrusive thoughts
The Reinforcing Properties of Worry
People with GAD think the benefits of worrying
are:
Avoidance of catastrophe
Avoidance of deeper emotional topics
Coping and preparation
Cognitive Biases for Threatening Information
People with GAD process threatening information
in a biased way, likely due to prominent danger
schemas
Are more likely to think that bad things are likely
to happen in the future
Tend to interpret uncertain stimuli as threats
(Pearson Education Ltd., 2021; APA, 2023)
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5. Diagnostic Criteria
A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities.
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been
present for more days than not for the past 6 months):
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (such as a drug of abuse, a medication) or another medical
condition (such as hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (APA, 2023).

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6. Prevalence
The 12-month prevalence of GAD in the general community of the United States (APA, 2023);

• among
adolescents The lifetime
morbid risk is
0.9 9.0%.
% The 12-month
prevalence for
the disorder in
2.9 % other countries
ranges from
•among 0.4% to 3.6%.
adults

Females are twice as likely as males to experience GAD.

The prevalence of the diagnosis peaks in middle age and declines across the later years (Pearson
of life. Education Ltd., 2021; APA, 2023)

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 7. Comorbidty
Individuals whose presentation meets criteria for generalized anxiety disorder are likely to have met, or
currently meet, criteria for…

other anxiety disorders depressive disorders substance use

In females, comorbidity is largely confined to the anxiety disorders and

depression, whereas in males, comorbidity is more likely to extend to the
substance use disorders as well (APA, 2023).

(Pearson Education Ltd., 2021; APA, 2023)

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8. Risk and Prognostic Factors
Temperamental:
Behavioral inhibition, negative
affectivity (neuroticism), and
harm avoidance have been
associated with GAD.
Environmental:
Although childhood adversities
and parental overprotection
have been associated with
generalized anxiety disorder, no
environmental factors have
been identified as specific to
generalized anxiety disorder or
necessary or sufficient for
making the diagnosis.
Genetic and physiological.
One-third of the risk of
experiencing generalized
anxiety disorder is genetic, and
these genetic factors overlap
with the risk of neuroticism and
are shared with other anxiety
and mood disorders,
particularly major depressive
disorder.
(Pearson Education Ltd., 2021; APA, 2023)
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9. Clinical Evaluation

Positive Disorder
Intolerance Specific
Beliefs
of Intolerance
SCID GAD-7 Uncertainty
about the GAD
Worry of
Scale Uncertainty
Scale
Scale Scale

Beck Depression Inventory and Beck Anxiety Inventory can be used.

(Pearson Education Ltd., 2021; APA, 2023)

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10. Treatments of GAD
Medical Treatment; At
times performance anxiety may be so
significant that medication may be
indicated so that individuals are better
CBT; an effective treatment for able to engage in the ‘talking therapy’
GAD. It teaches client how to re-appraise and undertake exposure exercises.
self-talk that heightens her anxiety, and Benzodiazepines are used for tension
teaches client how to manage her anxiety relief, reduction of other somatic
with time and practice. Exposure therapy symptoms, and relaxation. Several
is used as part of CBT to increase distress categories of antidepressants are also
tolerance. used.

ACT; teach individuals to have a

different relationship with their thoughts
(detaching). ACT also encourages
individuals to live alongside their
worries, and move towards living a
values-based life.

(Pearson Education Ltd., 2021; APA, 2023)

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11. CBT-based Models (Dugas, Borkovec, Wells)

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Social Anxiety Disorder
Definition
• Social anxiety disorder (social phobia): characterized by disabling fears of 1 or
more specific social situations
• Underlying fear of exposure to scrutiny and potential negative evaluation by others
• Two subtypes:
• Performance (e.g., public speaking)
• Nonperformance (e.g., eating in public)
Prevalence, Age of Onset, and Gender Differences

• About 12 percent of the population meets the diagnostic criteria at some point in
their lives
• Typically begins in adolescence or early adulthood
• More common in women
• Often present along with other anxiety disorders and/or use of alcohol to cope
with social situations
• Comorbidities suggest that anxiety disorders may be best understood as causally connected
networks of symptoms, rather than individual disorders
Psychological Causal Factors

SOCIAL ANXIETY AS LEARNED BEHAVIOR

• Originates from direct or vicarious classical conditioning
• Being or witnessing someone else being a target of anger or criticism
• Experiencing or witnessing a perceived social defeat or humiliation
SOCIAL FEARS AND PHOBIA IN AN EVOLUTIONARY CONTEXT
• Evolutionarily based predisposition to acquire fears of social stimuli that signal
dominance/aggression from other humans, such as facial expressions for anger or
contempt
• Evolved as by-product of dominance hierarchies among primates
COGNITIVE BIASES
• People with social anxiety tend to expect that other people will reject or
negatively evaluate them
• Individuals with social anxiety are preoccupied with bodily responses and negative self-
images in social situations
Biological Causal Factors

• The most important temperamental variable is behavioral inhibition

• Children assessed as being high on behavioral inhibition between 2-6
years of age were three times more likely to be diagnosed with social
phobia
• Modest genetic contribution to social phobia
Treatments

COGNITIVE AND BEHAVIORAL THERAPIES

• Prolonged and graduated exposure to the feared situation has proven to be a very
effective treatment
• Cognitive restructuring: therapist attempts to help client identify their underlying negative thoughts
and change them
MEDICATIONS
• Sometimes effective for treating social anxiety; antidepressants are most effective/widely
used
• Cognitive-behavioral therapies generally produce more long-lasting improvements with
very low relapse rates