Generalized Anxiety Disorder
• One of the more difficult anxiety presentations to treat effectively because:
o It reflects a kind of long standing nature that leans towards characterization of neuroticism
anxious by nature; quite worried
o Often shows up early in life and presents as being separation anxiety worries; being
accepted by friends; can I get into University etc.
o Gets worse with age; most other anxiety disorders mellow out through time. This one does
not it gets worse over time.
Burden that life has offer you increases over time (number of worries and number of
people in your life increases; mortgage, children; retirement; grandchildren etc.)
o Group treatment = not a whole lot better outcome than placebo. The treatment outcome is
about 50/50 depending on the clients’ motivation to change.
o Folks with GAD ha e a lot of dysfunctional beliefs about the function and role and benefit of
worry and anxiety related behaviours. Sometimes there is a pretty striking lack of insight
about how problematic worrying is. Ex: think if they stop worrying, they will go crazy
• Must see for at least 6 months
• How do you judge what excessive anxiety and worry? Ask them if the average person was placed into
your situation would they worry less, the same or more. Really helpful in contextualizing worry.
• Often Depression + chaotic lifestyle can mask itself as GAD.
• Restlessness often manifests itself in behavioural output (shaking knee, rubbing hands back &
• Irritability particularly bad. Sometimes therapist is recipient of this anxiety. Irritability often
comes out in treatment when you challenge the functional impact of the worry. Clients get defensive
• Sleep disturbance initiating and staying asleep
• 2-5% of population throughout lifetime
• Age of onset (31) is pretty late more responsibility in career, kids, paying down loans etc.
• Early teens and early 20’s is a hot zone for many mental health issues to arise. • Even though diagnoses is late, it is a gradual onset with markers often showing in childhood
• Women similar to other mental illnesses included Depression
• GAD and Depression go together so frequently treatment groups are now being considered to be
• Presence of worrying related to minor matters (which way will I drive there, can I use a parking
machine correctly, what if I can’t find the door to the office etc.)
• It has to be a broadband worry worrying about many things, not just one specific thing.
Although can worry about one or two things mostly, but all others in general.
• Sometimes GAD worries can be especially on health factors differentiating between
• Current Events Facebook, watching the new etc.
o Not watching the news = avoidance: Refer back to the Trigger thoughts emotions
behaviour physical = AVOID (avoiding strengthens anxious thoughts)
• Paralyzed by making decisions opinion shopping (asking 15 people), excessive researching
• Troublesome behaviour for GAD constant reassurance seeking
GAD & Depression
• 20% of people with Depression also have GAD
• Can also be diagnosed with mixed anxiety-depressive disorder
• Lower treatment response when the two are together. Real barrier to treatment sometimes because
they are depressed but the anxiety inhibits/ delays treatment (anxiety over SSRI’s, treatment etc.)
• Substance abuse pot and alcohol. Long-term not ideal causes more stress
GAD & Physical Illness
• Cardiovascular illness
• Cerebrovascular illness (stroke) 15-20% of people have silent strokes and are highly correlated
with Depression. Treatment resistant depression may be neurological representation due to
stroke? It’s still being determined.
• Pulmonary diseases • Health psychology level increased Cortisol, depression of immune system, a lot more wear
and tear your body has to deal with when you are under stress. Lifestyle factors go by the waste
side when you are stressed out too. Not sleeping, not socializing etc. Put all together is heafty
• Psychodynamic Theories
o Anxiety results from inability to resolve different conflicts between the different levels of
the mind (id, ego, superego)
o Id = Primal urges; ego = societal pressure; superego =man in the middle
o No evidence that is true; he doesn’t know anyone using Psychodynamic to treat GAD
• Humanistic and Existential Theories
o Existential anxiety pretty interesting; what’s it all about, why am I here; what does my
life mean; what is worth? Etc. Lots of highly intellectual CEO’s and people high up in
their field can sometimes think themselves into these patterns.
Tolerance of Uncertainty Model of GAD
• Folks with GAD have core belief that worry will protect me and help me break through
• Worry leads to behavioural and cognitive avoidance takes emphasis away from the problem
and gets displaced. The worry becomes a distraction for everything.
• It all becomes about managing how the person is feeling about the situation rather than doing
something about the situation
• Eventually cannot distract self anymore psychological and physiological exhaustion occurs =
emergence of symptoms.
• Neurotransmitter Diagram on the Board
o Normal Conditions reservoir = half full
o Acute Stress reservoir = up-regulate neurotransmitters fills reservoir almost to the
o Chronic Stress less productive than you were previously and same with
neurotransmitter levels. Because you become exhausted. Depletes the neurotransmitter
stores and this is the time when symptoms occur Metacognitive Model of GAD
• Two types of worries:
o Type 1:
physical symptoms: what if I get cancer, what if I lose my job
o Type 2:
Meta-worry negative beliefs about the worry itself.
“What if I get so worried that I go crazy and I end up killing people in my
Similar to panic panic of the mind.
Catastrophizing about innocuous thoughts see themselves depressed, what if I
am depressed? What if I kill myself? Etc.
Sometimes clients will start to use you have to be careful that you don’t
become the safety behaviour.
Thought suppression reinforces that thoughts are bad. Assume that the default
is to be anxious; that’s the norm. If that’s your baseline, if you happen to not feel
anxious that’s even better. But it takes the pressure off.
Intervention used for worrying imagine you just gone to the Dr. You come
into the office and he tells you, you have cancer. No radiation or Chemo or
Surgery. All I want you to do for the next 6 months is worry about it. What
would you say? You would say let’s do something for it!! Cut it out, or chemicals
etc. This gets the client to kind of understand how usele