2. Generalized Anxiety Disorder
Prevalence:
“GAD affects about 6.8 million American adults, including
twice as many women as men. The disorder develops
gradually and can begin at any point in the life cycle,
although the years of highest risk are between childhood and
middle age.”
(National Institute , Oct. 2011)
3. Prevalence:
“…nearly 17.6 million adults in the United States are
alcoholics or have alcohol problems.”
(National Institute of, 2011)
“…young adults aged 18 to 29 are the most likely to have
alcohol problems.”
(Nathan, P., Wallace, J., Zweben J. & Horvath, A., 2012)
4. DSM IV Diagnostic Criteria
Generalized Anxiety Disorder 300.02
Excessive worry, anxiety, apprehension 6+ months
Inability to control worrisome thoughts/feelings
Cognitions are generalized
Clinically significant impairment in functioning
Not substance induced
Minimum of 3 (of 6 listed) symptoms present
only 1 symptom required for children
(Dsm-5 development, 2012)
5. DSM IV Diagnostic Criteria
Alcohol Abuse 305.00
Significant impairment of function (one or more)
Failure to fulfill obligations either social or
occupational
Use of substance negligently or hazardously
Legal issues resulting from substance use
Continued use despite knowledge of
social/interpersonal problems
Symptoms do not meet criteria for dependence
(Office of the Surgeon General, 2007)
6. DSM IV Diagnostic Criteria
Alcohol Dependence 303.90
Tolerance-needing more to produce same effect and/or
Withdrawal upon cessation
Large amounts and prolonged use
Inability to cut back or stop usage
Activities lessened or eliminated due to usage
Physical and psychological problems not deterring
Excessive time spent obtaining/using substance
(American Psychiatric Association, 2012)
8. Physiological: “Autonomic Restrictors”
Lessened responsiveness to stressors than exhibited in other
anxiety disorders.
Physiological measures included heart rate, blood pressure,
skin conductance and respiration rate, and muscle tension.
“People with GAD are chronically tense.”
(Durand & Barlow, 2010)
9. Biological: Generalized Vulnerability
“What seems to be inherited is the tendency to become
anxious rather than GAD itself.” Kendler and colleagues
Generalized Anxiety Disorder tends to run in families;
this is hypothesis is strengthened by
twin studies.
(Durand & Barlow, 2010)
10. Cognitive: Image Avoidant
There is an acute awareness to threats, especially personal
ones, in individuals with GAD. MacLeod and Mathews
(1991) concluded that words are more important than colors.
Autonomic Restriction occurs due to
Ω kind of worry produced
Ω automatic or unconscious
Ω is intense, or frantic.
EEG activities showed
Ω restriction of peripheral autonomic arousal
Ω intense cognitive processing
Ω in the left hemisphere
(Durand & Barlow, 2010)
11. Developmental: Fearing the Worst
GAD can be learned through
restrictive parenting, or other
early experiences (that restrict the child’s autonomy)
belief that life events are uncontrollable/dangerous
(generalized psychological vulnerability)
stress from life events
intense worry produces physiological changes
There are many relevant studies suggesting that this high
degree of sensitivity resulted from a stressful experience
during childhood when coping skills were premature.
(Durand & Barlow, 2010)
12. Social: Apprehensive/Negative
There are many factors that contribute to the development of
anxiety; perceived stress arises from many sources.
Negative life events
Separation during childhood
Role inversion during childhood
Lack of social interactions
Poor life satisfaction
Modeling of relative with anxiety disorder
(Gosselin & Laberge, 2003)
14. Expectancy Effect
Expectancy about drugs, or how you expect to feel,
act and be treated by others, are formed before use
ever begins. After use, these expectancies can
change, depending upon the environment and
responses.
Meaghan Morean and colleagues have developed a new test for
alcohol expectancy, AEAS (Anticipated Effects of Alcohol
Scales) published June 18 of this year in Psychological
Assessment (American Psychological Association).
Link to ebscohost
(Morean, Corbin & Treat, 2012).
15. Disease Model
The acceptance of powerlessness as biological/incurable
Pros: benefits the individual in that they are encouraged to
seek treatment for their problem.
Cons: provides an excuse for relapse and some become
discouraged by the thought of a lifetime dealing with the
illness.
AA and similar groups offer support systems, based upon
a 12 step approach, that can be used for self improvement in
many areas, not just addiction.
(Alcoholics Anonymous, 2002) (Durand & Barlow, 2010)
16. Moral Weakness Model
Client needs and beliefs must be determined in order to approach these
models successfully. Some clients will need to accept “powerlessness”
before they can begin to incorporate this model. Acceptance of this model
for these individuals may be incorporated after the biological approach has
established AA stability (has chosen a sponsor), and client has reached
step four.
(Donovan,D;O’Leary,M.,1978)(NationalInstituteof,2011)
(AlcoholicsAnonymous,2002)(Durand&Barlow,2010)
17. Treatments for Dual Diagnosis
A dual diagnosis requires an integrative approach and acceptance of all
contributing factors and accepted models, for each disorder.
Moral weakness/
Cognitive
• CBT (Cognitive Behavioral Therapy)
• Religious support
Biological-Disease
• Abstinence
• Establish Identity-AA/NA
• Physical health issues addressed
Social/Environmental
• Habiliate/Rehabilitate
• Improve/establish Coping skills
Learning/Modeling
• Behavior Therapy
• Reinforcement Negative/Positive
• Meditational approach
Symptom/self-
medication
• Identify/treat coexisting disorder
• Maintain medication compliance
(Durand&Barlow,2010)
19. Alternative Medications-GAD
Kava Kavapyrone has been studied for effectiveness in
treating anxiety. Do not use when drinking, on
benzodiazepines, L-dopa, Nembutal, or Xanax
Valerian helps you sleep and has been used for
restlessness, sleep disorders and tension. Do not use when
drinking or on Antabuse.
Vitamin B and folic acid “These nutrients may
relieve anxiety by affecting the production of chemicals
needed for your brain to function
(neurotransmitters).”
(Mayo Staff Clinic, 2011) (Fetrow, C. & Avila, J., 2000)
20. CBT/Med Compliance
• Avoid fatty foods
• Add omega-3 and Vit. B
• Exercise
• Relaxation Techniques
• Yoga
• Visualization/Meditation
• Social Support/AA
21. References
Alcoholics Anonymous World Services (2002, May 09). The Twelve Steps of
Alcoholics Anonymous. Retrieved October 10,2012 from http://www.
aa.org/en_pdfs/smf-121_en.pdf
American Psychiatric Association. (2012). Alcohol Abuse. Retrieved October
07,2012 from http://dsm5.org/proposedrevisions/pages/proposedrevision.
aspx?rid=247
Dsm-5 Development (April 30,2012). Proposed Revision: Generalized Anxiety
Disorder. Retrieved on October 08,2012, from http://www.dsm5.org/
ProposedRevisions/Pages/proposedrevision.aspx?rid=167
American Psychiatric Association. (2012). Alcohol Dependence. Retrieved
October 07,2012 from http://www.dsm5.org/ProposedRevisions/Pages/
Proposedrevision.aspx? Rid=167
22. Durand, V. M., & Barlow, D. H. (2010). Essentials of abnormal psychology.
(pp. 123-127, 392-402). Belmont, CA: Wadsworth Cengage Learning.
Donovan, Dennis M.; O'Leary, Michael R. (1978). The drinking-related
locus of control scale: Journal of Studies on Alcohol, Vol 39(5), 759-
784 [Abstract]. Retrieved October 12,2012 from http://psycnet.apa.org
psycinfo/1979-30081-001
Fetrow, C. W., Avila, J. R. (2000). Complete Guide to Herbal Medicines. (pp.
307-309, 553-555). New York, NY: Springhouse Corporation.
Gosselin, P., & Laberge, B. (2003, July 29). Etiological factors of generalized
anxiety disorder. Retrieved October 07,2012 from http://www.ncbi.nih.gov/
pubmed/1461505
Hefner, C. (2011, November 29). Psychiatric disorders: Generalized anxiety
disorder. Retrieved October 08,2012 from http://allpsych.com/disorders/
anxiety/generalizedanxiety.html
23. National Institute of Mental Health. (2011). Assessing Alcohol Problems: A
Guide for Clinicians and Researchers (p. 380,668). Retrieved October 10,
2012 from http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/
factsheets.pdf
Mayo Staff Clinic. (2011). Generalize anxiety disorder: Alternative medicine.
Retrieved October 07,2012 from http://www.mayoclinic.com/health/
generalized-anxiety-disorder/DS00502/DSECTION=alternative-medicine
Morean, M. E., Corbin, W. R., & Treat, T. A. (2012). The Anticipated Effects of
Alcohol Scale: Development and Psychometric Evaluation of a Novel
Assessment Tool for Measuring Alcohol Expectancies. Psychological
Assessment, doi:10.1037/a0028982
Nathan, P., Wallace, J., Zweben, P., Horvath, A. (2012, March). Understanding
standing Alcohol Use Disorders and Their Treatment. Retrieved October
7,2012 from http://www.apa.org/helpcenter/alcohol-disorders.aspx
24. Office of the Surgeon General (US); National Institute on Alcohol Abuse and
Alcoholism (US); Substance Abuse and Mental Health Services Administration
(US). The Surgeon General's Call to Action To Prevent and Reduce Underage
Drinking. Rockville (MD): Office of the Surgeon General (US); 2007. Appendix B:
DSM-IV-TR Diagnostic Criteria for Alcohol Abuse and Dependence. Retrieved
October 08,2012, from http://www.ncbi.nlm.nih.gov/books/NBK44358/
Nathan, P., Wallace, J., Zweben, P., Horvath, A. (2012, March). Understanding
Alcohol Use Disorders and Their Treatment. Retrieved October 7,2012, from
http://www.apa.org/helpcenter/alcohol-disorders.aspx
Editor's Notes
Abnormal Psychology presentation by Nancy Frishkorn October 19,2012
People with GAD express exaggerated worry without provocation. They appear overly concerned about future events such as financial or occupational loss, family and marital issues, and often health issues, present or anticipated. Problems with sleep regulation and daily activities are significantly impaired. They are often restless, exhibit a pessimistic personality, and their physical symptoms vary depending upon the severity of the illness.
Link to National Institute of Mental Health by clicking the title (http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml)
Alcohol dependence occurs after use has exceeded accepted standards of occasional use. These limits are designated by the medical profession and are available in the DSM IV under diagnostic criteria. Here you will find a specific list that will determine whether the person has an alcohol abuse or an alcohol dependency. Click the title to follow this link to http://www.apa.org/helpcenter/alcohol-disorders.aspx
The title link will redirect you to the new proposal for DSM-V http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=167#
Click this title to see the code/proposed revisions- http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=247# (code only)
http://www.ncbi.nlm.nih.gov/books/NBK44358/
Click the title to follow this link to see the code/proposed revisions http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=36#
Generalized anxiety disorder is the result of many contributing factors. It is important to understand all of the potential theories in order to determine an appropriate bio psychosocial treatment plan for the client. http://allpsych.com/disorders/anxiety/generalizedanxiety.html
Muscle tension is a unique characteristic of GAD that is not shared with the other anxiety disorders. Studies conducted have found that these people have a lesser response to stimulus than do those with panic tendencies. What this means is that, instead of a flight/fight response as typically seen with specific anxiety, these people will have lower than expected biological /physical response to stressors.
This inherited tendency can develop into generalized anxiety providing the environmental influences support such development. It has also been shown that children who are genetically susceptible do not always develop this disorder, providing they are offered a supportive and constructive environment.
EEG and fMRI results should always be obtained before diagnosis and treatment can begin. It is important to rule out physical factors first, which can include brain damage, seizure activities, and chemical imbalances, that may require medications, surgeries, or other medical procedures.
There is no possible way anyone can become a perfect parent, but what is important is that they try to be a good enough parent. If you have anxiety or excessive worry and fear, your child will model this behavior, and could become more susceptible to developing generalized anxiety disorder. A good suggestion is to make sure your child has a diversity of experiences with many people, including their peers, so that they may learn to experience everything in their own unique way.
Sometimes bad things happen, and these chance factors can have a negative impact upon one’s development. There are many social services available, and these outside influences may better serve in the child's/individuals best interest when a family has to deal with a crisis. For more detail click the “cup” to link to the national institute of mental health at
http://www.ncbi.nlm.nih.gov/pubmed/14615705
There are many causes of alcohol and drug use/abuse, the book mentions five in particular that are currently accepted models of etiology. Two of these were highlighted, as was the theory of the expectancy effect, and are further explored in the linked slides. These occurrences do not have to occur in this particular order, but all are present if dependence is established.
Expectancy effect is the basically the thoughts you have, not only about using the drug, but how you will feel when under its influence, as well as how you expect to be treated and behave while using. For example-tolerance to the impairing effects of alcohol use is easily attained if the person receives positive reinforcement for controlling the behavior when intoxicated. Additionally, impairment is attained even when little use has occurred if the proceeding cognitions “expect” the effect. Have you ever seen someone have one drink and then dance on the tables as if completely intoxicated? Or do you know a diagnosed alcoholic who can have two sips and already be talkative and acting impaired? This is because they EXPECT to feel a certain way, which was established by the mediating factors, such as the positive or negative reinforcement they received from their peers early on, so they behavior they express exhibits the expectancy that they held before the act even occurred. The AEAS is a screening tool that can help you establish what the person’s beliefs, whether rational or not, are about their drug use. Many people are in denial about the severity of their use, and many are defensive; this screening test can help you determine the proper course of therapy in these difficult cases.
http://ehis.ebscohost.com.navigator-cup.passhe.edu/eds/detail?vid=3&hid=5&sid=1a503a59-57b7-455e-9bdc-4c5a63f3cdf3%40sessionmgr4&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=pdh&AN=pas-2012-15950-001
Another benefit this model has over the moral weakness model is in the treatment. When building self-efficacy and a strong sense of internal control, a “dually” may be tempted to “control” their addiction rather than abstaining from it. It is important to keep your particular client’s needs and beliefs in mind when considering a course or treatment plan that will best suit their needs.
Click 12 Step to link to AA at http://www.aa.org/en_pdfs/smf-121_en.pdf
This model applies a negative connotation to the client/sufferer. Some events can lead one to believe they are “dammed” or “bad people” which is a maladaptive thought process. These people may be better served through CBT and/or religious counseling rather than religious consoling alone. Accepting responsibility for one’s action has positive effects, but this increased sense of control could become counterproductive when dealing with addiction disorders, as the client may believe they can control their use, or worse, no longer need treatment. Click step four to link to http://www.aa.org/en_pdfs/smf-121_en.pdf . Click the DRIE scale to open a .pdf from the national institute that lists EVERY test available and its purpose! This link is AWESOME for testing systems class as well! http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/factsheets.pdf
The successful application of treatment should include factors from all five areas of origin. Tailoring treatment to any individual can take not only significant time, but also a factor of trust between therapist and client. Open ended questions, positive regard, and reliable testing can assist in the determination of diagnostic criteria fulfillment and further understanding of the individuals particular needs.
There are many medications currently in use for these disorders. Determination of medication type and regimen should be at the discretion of the MD or psychiatrist prescribing, but cooperation with these individuals as to additional treatments and alternative treatments will greatly enhance the client’s outcome.
These are just a few accepted alternative medicines acknowledged by the Mayo Staff Clinic for treatment of generalized anxiety. The herbs are not FDA regulated, and should not be taken without consulting with an MD first. There are many claims that other herbs are also beneficial, but they have not been recognized through sufficient studies to date. This information can be further explored by following this link http://www.mayoclinic.com/health/generalized-anxiety-
These steps will cover all the models, as well as provide the client with an integrated approach that is easy to maintain. It would be beneficial for the therapist to become aware of social groups or religious services that offer classes/participation in these methodologies in the area in which they serve. Many chiropractors also offer alternative medication therapies/treatments so it would be in your best interest to become familiar with others practicing within your community. Keep pamphlets for yoga, meditation, and AA/NA support groups in the lobby areas to encourage participation for those who have reservations about sharing certain issues in therapy sessions. Working with a dietician may also be beneficial in some cases, as well as encouraging participation in fundraising events, such as walks or biking events, by providing flyers and local event publications. Remember, social support can improve EVERY illness, and the more we work together, the sooner we can help these people return to happy, productive lives.
