Psychology
General Anxiety Disorder
Generalized Anxiety Disorder (GAD) is a mental health condition characterized by excessive and uncontrollable worry about various aspects of life, often without a specific cause. Individuals with GAD may experience physical symptoms such as restlessness, irritability, muscle tension, and difficulty concentrating. The condition can significantly impact daily functioning and quality of life.
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12 Key excerpts on "General Anxiety Disorder"
- Michael B. First, Allan Tasman(Authors)
- 2013(Publication Date)
- Wiley(Publisher)
F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medica- tion) or a general medical condition (e.g., hyperthyroid- ism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive develop- mental disorder. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Rev. Copyright 2000 American Psychiatric Association. Generalized Anxiety Disorder (GAD) is defined as excessive anxiety and worry (apprehensive expecta- tion), occurring for a majority of days during at least a six-month period, about a number of events or activi- ties (such as work or school performance). In individuals with GAD, the anxiety and worry are accompanied by at least three of six somatic symptoms (only one accom- panying symptom is required in children), which include restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance. In addition, the affected individual has difficulty control- ling his or her worry, and the anxiety, worry, or somatic symptoms cause clinically significant distress or im- pairment in social, occupational, and/or other important areas of functioning. Further, the GAD symptoms should not be due to the direct physiological effects of a substance such as drugs or alcohol or a general medical condition, and should not occur exclusively during a mood disorder, psychotic disorder, or pervasive devel- opmental disorder. Worry and anxiety are part of normal human behav- ior and it may be difficult to define a cut-off point distinguishing normal or trait anxiety (i.e. a relatively stable tendency to perceive various situations as threat- ening) from GAD.
eBook - PDFClinical Handbook of Psychological Disorders
A Step-by-Step Treatment Manual
- David H. Barlow(Author)
- 2021(Publication Date)
- The Guilford Press(Publisher)
184 Generalized anxiety disorder (GAD) has been called the “basic” anxiety disorder, in the sense that generalized anxiety is, by definition, a component of other anxiety and related disorders. Indeed, GAD, although characterized by marked fluctuations, is chronic. Some have even considered that GAD might be better conceptualized as a personality disorder, or the clinical manifestation of the temperament of neuroticism itself, since many individuals with this problem cannot report a defini- tive age of onset; rather, they note that it has been with them all their lives. Psychological and drug treatments, although often evaluated, have not produced the robust results evident with some other anxiety disorders. For this reason, further study of new treatment protocols is all the more pressing. The protocol presented in this chapter, developed by Drs. Roemer and Orsillo at our Center for Anxiety and Related Disorders, illustrates a cutting-edge, acceptance-based approach to GAD that has achieved a high rate of success. This protocol also illustrates, along with Chapter 3 describing process-based cognitive-behavioral therapy for social anxiety disorder, principles associated with the so-called “third-wave” cognitive-behavioral approach to psychological disorders. Clinicians and students interested in how this approach is actually implemented will find the case study of “Héctor” particularly fascinating. —D. H. B. G eneralized anxiety disorder (GAD) is a chronic anx- iety disorder, centrally defined by excessive anxiety and worry (see American Psychiatric Association, 2013, for diagnostic criteria). Epidemiological studies in the United States have revealed a lifetime prevalence of 5.7–9.0% for GAD using DSM-IV criteria (Kessler et al., 2005; Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012), and 7.8% using DSM-5 criteria (Rus- cio et al., 2017). Lower lifetime prevalences have been reported in lower- and middle-income countries (Rus- cio et al., 2017).
eBook - ePub- Mike Thomas, Mandy Drake(Authors)
- 2011(Publication Date)
- SAGE Publications Ltd(Publisher)
7Client Presenting with Generalised Anxiety Disorder (GAD)
Matt Bowen and Dennis Turner
Learning objectives By the end of the chapter you should be able to: Identify the nature and symptoms of Generalised Anxiety Disorder (GAD) Explain the development and maintenance factors of GAD from a cognitive perspective Outline a cognitive and behavioural strategy used in the treatment of GADDiagnostic criteria
Generalised anxiety disorder (GAD) is characterised by excessive, intrusive and difficult to control worry. It is a ‘free-floating’ worry that, as noted in the DSM-IV-TR code 300.02 (APA, 2000), is not focused exclusively on having a panic attack (panic disorder), concerns about contamination (OCD), anxiety about social contact (social phobia), physical complaints (somatisation disorder) or illness (hypochondriasis). The anxiety and worry may well revolve around a number of the above issues; however, the ‘free-floating’ nature of the anxiety often means that the specific nature of the worry seems difficult to identify as it moves from one area to another. This feature is supported by Stober and Borkovec (2002) who noted the limited capacity of individuals experiencing GAD to provide concrete and specific accounts of their worries.For a clinical diagnosis, using the DSM-IV-TR (APA, 2000) criteria, the excessive and difficult to control worry must have lasted for at least six months and to have been present for more days than not during that time. Additionally the client must demonstrate at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension or sleep disturbance. It is commonly the somatic problems that bring the individual into contact with services rather than their concern about their difficulty in controlling worry (Flint, 2005).
eBook - PDF- Timothy Brown, David Barlow(Authors)
- 2016(Publication Date)
- Cengage Learning EMEA(Publisher)
At the beginning of treatment, Adrian displayed all of the symptoms of DSM-5 generalized anxiety disorder (GAD) (American Psychiatric Association, 2013). In DSM-5 , GAD is defined by the following features: (a) the person experi-ences excessive anxiety and worry about a number of events or activities (such as work or school performance) and this occurs more days than not for at least 6 months; (b) the person finds it difficult to control the worry; and (c) the anxiety and worry are associated with three (or more) of the following six symptoms: rest-lessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrat-ing or mind going blank, irritability, muscle tension, and sleep disturbance (difficulty in falling or staying asleep, or restless, unsatisfying sleep). To warrant a DSM-5 diagnosis, these symptoms must cause the person considerable distress or lifestyle interference. Moreover, a diagnosis of GAD is ruled out when the symp-toms of worry and generalized anxiety are better accounted for by another emo-tional disorder (e.g., worry about having unexpected panic attacks, as in panic disorder, should not be considered as contributing to a GAD diagnosis), the phys-ical effects of a substance (e.g., drugs of abuse, medications), or a general medical condition (e.g., hyperthyroidism). In the preceding editions of the DSM , GAD was not assigned when its symp-toms (i.e., chronic anxiety and worry) occurred exclusively during the course of a mood disorder (e.g., major depression, bipolar disorder) or posttraumatic stress dis-order. In DSM-5 , this diagnostic hierarchy rule was removed meaning that a GAD 4 Case 1 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300 diagnosis is now permissible even when the disturbance occurs at the same time as a mood disorder or a posttraumatic stress disorder.
No longer available |Learn more- (Author)
- 2014(Publication Date)
- The English Press(Publisher)
________________________ WORLD TECHNOLOGIES ________________________ Chapter-3 Generalized Anxiety Disorder Generalized anxiety disorder ( GAD ) is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friend problems, relationship problems or work difficulties. They often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, bouts of difficulty breathing, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, and rashes and inability to fully control the anxiety. (ICD-10. These symptoms must be consistent and on-going, persisting at least 6 months, for a formal diagnosis of GAD to be introduced.Generalised anxiety disorder is estimated to occur in 5% of the general population. Women are generally more affected than men (Vanin, Helsley, 2008). Prevalence The World Health Organization's Global Burden of Disease project did not include generalized anxiety disorders. In lieu of global statistics, here are some prevalence rates from around the world: • Australia: 3 percent of adults • Canada: Between 3-5 percent of adults • Italy: 2.9 percent • Taiwan: 0.4 percent • United States: approx. 3.1 percent of people age 18 and over in a given year (9.5 million) 55 to 60 percent of people diagnosed in clinical settings are women. Epidemiology The usual age of onset is variable - from childhood to late adulthood, with the median age of onset being approximately 31 (Kessler, Berguland, et al., 2005). Most studies find that
eBook - ePubCognitive Behavioral Treatment for Generalized Anxiety Disorder
From Science to Practice
- Melisa Robichaud, Naomi Koerner, Michel J. Dugas(Authors)
- 2019(Publication Date)
- Routledge(Publisher)
Catherine was skeptical about the benefit of any form of psychological treatment, since she thought she had “the worrying gene” and was unlikely to change this part of her character. However, she was tired of “always feeling stressed out and anxious” and was willing to try anything to stop feeling this way. When she presented for treatment, she received an in-depth assessment. Based on her report of excessive worry about a number of daily life events, and her endorsement of somatic symptoms such as fatigue, sleep difficulties, and feelings of restlessness, she was given a diagnosis of generalized anxiety disorder (GAD).As can be seen from the preceding illustration of Catherine, GAD can easily become quite debilitating, and can greatly reduce one’s quality of life. Unfortunately, people afflicted with GAD rarely seek professional help, and when they do, clinicians often have difficulty recognizing the symptoms as being those of GAD. For these reasons, we will attempt to accomplish two major goals in this introductory chapter. The first is to provide a relatively thorough description of the characteristics of GAD. Specifically, we will discuss the history of the diagnostic category, the prevalence and associated features of the disorder, and the impairment that GAD typically engenders. The second goal is to present a “picture” of what GAD looks like from the clinician’s point of view. What do we mean when we say “excessive worry and anxiety about a number of events or activities?” What is daily life like for someone with GAD? The above description of Catherine is only one example of the many ways in which GAD clients can present for treatment. It is our hope that, by thoroughly presenting information gathered over the course of our clinical practice, we can begin to provide a detailed picture of this fascinating and complex disorder.Diagnosis of GAD
Generalized anxiety disorder is a diagnostic category that has undergone several changes within different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1980, 1987, 1994, 2000, 2013). As such, it should come as no surprise that the diagnosis of GAD is at times confusing, even for anxiety disorder specialists. In the following section, we will review the evolution of GAD in the DSM
eBook - ePubCognitive Therapy of Anxiety Disorders
A Practice Manual and Conceptual Guide
- Adrian Wells(Author)
- 2013(Publication Date)
- Wiley(Publisher)
Chapter 8
GENERALISED ANXIETY DISORDER
Generalised anxiety disorder (GAD) is a common problem. The one-year prevalence rate in a community sample was approximately 3 per cent, and the lifetime prevalence was 5 per cent (DSM-IV; APA, 1994). The incidence among patients presenting at anxiety clinics is about 12 per cent. However, there have been few attempts to develop a specific cognitive model of GAD, possibly because the disorder only emerged from its status as a residual category in 1987 with the advent of DSM-III-R. Nevertheless, cognitive-behavioural interventions for GAD have been evaluated in a number of studies. These approaches have combined cognitive and behavioural methods without necessarily using a unifying-rationale or disorder-specific model. Even so, significant effects have been obtained (e.g. Butler, Cullingham, Hibbert, Klimes & Gelder, 1987) and studies show some superiority of cognitive methods over other forms of treatment (Durham & Turvey, 1987; Borkovec et al., 1987; Power, Jerrom, Simpson, Mitchell & Swanson, 1989; Butler, Fennell, Robson & Gelder, 1991). Borkovec and Costello (1993) compared applied relaxation with cognitive-behaviour therapy, and showed an advantage for the cognitive intervention. Durham et al. (1994) also report an advantage for cognitive therapy compared with analytic psychotherapy. In general, improved functioning is obtained in about half of the patients treated. There is clearly room for improvement in outcome. As specific cognitive models of GAD are advanced and drive treatment practises, treatment outcome should improve. This chapter outlines Wells’s (1994a, 1995) model and the treatment derived from it.Worrying is recognised as a predominant characteristic of GAD. According to DSM-IV (APA, 1994) GAD is defined as: Excessive anxiety and worry occurring more days than not for a minimum of six months about a number of events. The person should find the worry difficult to control, and should report at least three of the following symptoms: restlessness or feeling keyed up and on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance (difficulty falling asleep, staying asleep, or restless unsatisfying sleep). The focus of anxiety and worry should not be confined to another Axis I disorder (e.g. worry is not about being embarrassed in public as in social phobia). The anxiety and worry should cause significant distress or impairment in functioning, and the disturbance should not be due to substance effects such as drug use or medical conditions such as hyperthyroidism, or occur only during a mood disorder or psychotic disorder.
eBook - ePub- Matt Field, Sam Cartwright-Hatton, Author(Authors)
- 2015(Publication Date)
- SAGE Publications Ltd(Publisher)
6 Generalised Anxiety DisorderGeneral introduction
In this chapter we introduce the diagnostic criteria for generalised anxiety disorder, before considering its overlap with other mood and anxiety disorders. We then discuss how heritable and environmental factors, particularly parenting, may cause children to develop into anxious adults. The largest part of this chapter is devoted to a discussion of cognitive mechanisms in anxiety, particularly the roles of excessive worry and cognitive biases for threatening information. In the final part of the chapter, we consider how generalised anxiety disorder can be treated, and we evaluate whether treatments need to influence cognitive processes if they are to have a beneficial effect on anxiety.Assessment targets
At the end of the chapter, you should ask yourself the following questions:- Can I explain the diagnostic criteria for generalised anxiety disorder?
- Do I understand the roles of genetic and biological factors in generalised anxiety disorder?
- Can I explain how distorted cognitive processes might play a role in the initial development of generalised anxiety, and in the maintenance of the disorder?
- What can people do to help reduce their worrying?
- Do I understand how generalised anxiety disorder is treated, and can I relate treatments (particularly cognitive treatments) back to their theoretical models?
- Is cognitive bias modification likely to prove superior to existing treatments for generalised anxiety disorder?
Section 1: What is generalised anxiety disorder?
Diagnosis of generalised anxiety disorder
The primary feature of generalised anxiety disorder (GAD) is excessive worry that interferes with everyday functioning. This worry is associated with high levels of distress, and with concentration problems, sleep disruption and restlessness. Box 6.1 contains the diagnostic criteria for generalised anxiety disorder in ICD-10. The ICD-10 diagnostic criteria are similar to those provided in DSM-5, which are themselves largely unchanged from those in the previous version (DSM-IV) and the one before that (DSM
eBook - ePub- Robin McGill(Author)
- 2022(Publication Date)
- Youcanprint(Publisher)
Generalized anxiety is the susceptibility to engage in excessive panic, worry, or anxiety regarding numerous events or situations. Usually, the person has major difficulty controlling their feelings of worry and is associated with other symptoms such as fatigue, restlessness, concentration difficulties, sleep disturbance, irritability, and muscle tension. The feeling of worry is actually defined as a process where it is focused on the uncertainty of the outcome regarding future events. It is actually not an emotion itself, but it leads to feeling the emotion of anxiety. The main and most obvious symptom of generalized anxiety disorder is the “what if” thoughts that begin to occur. These “what if” thoughts work hand in hand with worrying, and it often feels like it is uncontrollable. In addition, the process of worry is often associated with physical symptoms that are related to the flight or fight response. It happens often that the individual will think of the future in a negative light and have thoughts that are followed by feelings of anxiety.People with GAD often feel worried and anxious most of the time and not just in specific situations that are stressful. The worries that they have been constant, intense, and interferes with their daily routine. Their worries are typically multiple aspects and not only one. It may include work, health, finance, family, or just everyday life things. Trivial tasks such as household chores or being late for a meeting can lead to extreme anxiety, which then leads to the feeling of doom.
- Michel Hersen, Peter Sturmey(Authors)
- 2012(Publication Date)
- Wiley(Publisher)
Chapter 28
Generalized Anxiety Disorder
ALLISON J. OUIMET, ROGER COVIN, DAVID J. A. DOZOISOVERVIEW OF DISORDER
Diagnostic Criteria
The objective of this chapter is to critically review the empirical evidence relevant to the treatment of generalized anxiety disorder (GAD) and provide a contemporary view of what can be considered best practice . Following a brief summary of the nature of the disorder, including diagnostic criteria, general characteristics, and overall burden, we provide a comprehensive review of the treatment outcome literature, with the primary goal of identifying current empirically supported treatments. Our hope is that this critical review can serve as a useful reference for professionals in both the research and clinical domains.The diagnostic criteria for GAD have changed dramatically over the years, as the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been revised. Consequently, understanding of the disorder has seemingly lagged behind that of other anxiety disorders. In DSM-III (American Psychiatric Association [APA], 1980), GAD was constructed as a residual anxiety diagnosis—meaning that a person was considered to have this disorder if he or she did not meet criteria for another anxiety disorder. This obviously made the clinical construct both vague and unspecified. It was not until publication of DSM-III-R (APA, 1987) that GAD was given more of an identity, as the criteria were significantly modified and pathological worry was considered the key criterion. Changes in the diagnostic criteria for GAD, which also occurred in the most recent version of DSM (i.e., DSM-IV
- Brian C. Chu, Sandra S. Pimentel(Authors)
- 2023(Publication Date)
- The Guilford Press(Publisher)
256 W orry is the fundamental aspect of generalized anxiety disorder (GAD) that leads to anxious apprehension, physical tension, and behavioral avoidance and escape. Worry is a cognitive feature of anxiety (Barlow, 1988) that reflects expansive and unconstructive attempts to problem-solve or plan for stressful life hassles and challenges. Worry itself is a natural reaction when the solution to a forthcoming problem is unclear, or the outcome of an upcoming challenge is unpredictable, or when the demands on one’s cognitive load exceed one’s capacity. When the worry process becomes difficult to interrupt or expands to multiple domains (school, social, work, family, the future), it can significantly limit the youth’s natural functioning and per- formance (Alfano, 2012; Roemer & Borkovec, 1993). Youth commonly engage in worry, with some evidence suggesting that a majority of children report excessive worrying at various points of childhood and adolescence, with older youth and girls appearing to exhibit higher levels of worry (see Bell-Dolan, Last, & Strauss, 1990; Songco, Hudson, & Fox, 2020). Community data on youth worries indicate that it is developmentally nor- mative for most youth to endorse at least some worries across domains, including health, safety, death, family, school, social issues, and community, and world events (Silverman, La Greca, & Wasserstein, 1995; Muris, Meesters, Merckelbach, Sermon, & Zwakhalen, 1998). The content of such worry is relatively similar between referred and nonreferred youth; what presents differently is the intensity, types, and uncontrollability of the worries (Weems, Silverman, & La Greca, 2000). Beyond worry, youth who meet formal criteria for GAD will endorse at least one physiological symptom, such as upset stomach, muscle tension, headaches, and difficulty concentrating.
eBook - ePub- V.E. Caballo(Author)
- 1998(Publication Date)
- Pergamon(Publisher)
The section on GAD includes items which cover DSM-IV diagnostic criteria as well as other items about worry themes, percentage of the day spent worrying, alcohol and drug consumption, physical condition, duration of the disorder, etc. Administration of the ADIS-IV typically takes 1–2 h and yields information on the presence of Axis I disorders with severity ratings. Measures of GAD Symptoms The first measure of GAD symptoms is the Worry and Anxiety Questionnaire (WAQ, Dugas, Freeston, Lachance, Provencher & Ladouceur, 1995a). The WAQ contains 16 items and is derived from the Generalized Anxiety Disorder Questionnaire (GADQ, Roemer, Posa & Borkovec, 1991b) which was updated to include all DSM-IV diagnostic criteria for GAD as well as current research questions about worry. GADQ dichotomous items were changed to continuous scale items (rated on a nine-point Likert-type scale) given earlier problems with high and unstable endorsement rates for some items (cf. Freeston et al., 1994a). The WAQ initially asks for a list of up to six worry themes which are then each rated for their excessive and realistic nature. Next, there are eight items about worry and anxiety which include three items from the GADQ (minor worries, percentage of thoughts and images, and percentage of the day spent worrying) and five items for DSM-IV GAD criteria. The WAQ also contains four items which are highly representative of related constructs, namely intolerance of uncertainty, thought suppression, problem orientation and perfectionism. Each one of these items was drawn from existing measures and had the highest corrected item-total correlation. The final item asks about physical health
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