psy634- competency #1 (1)

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1 Generalized Anxiety Disorder Melanie Somppi Department of Psychology, University of Phoenix PSY 634: Biological Basis of Behavior Dr. Rollo Jones November 21, 2023

2 Background Information & Common Symptoms Generalized Anxiety Disorder (GAD) is one of several different anxiety disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). A broad definition of GAD is, well, excessive anxiety. But receiving a diagnosis from a clinician for GAD requires a more lengthy and troublesome experience with anxiety on a day-to-day basis. The main diagnostic criteria for GAD in the DSM-5 is as follows “excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)” (DeMartini et al., 2019, p. 52). However, there are several other common symptoms associated with generalized anxiety disorder that also heavily contribute to a person’s everyday life. In fact, you must also experience three, if not more, of these symptoms to officially receive a GAD diagnosis. The symptoms included in the diagnostic criteria are: irritability, sleep disturbances, restlessness or on edge, muscle tension, easily fatigued, and difficulty concentrating or absent-minded (DeMartini et al., 2019). There are other symptoms associated with generalized anxiety disorder that someone may also experience (i.e. rapid heart rate or chest pains). A clinician must also ensure that the symptoms cannot be better explained by a different mental disorder or medical condition. Neurophysiological Underpinnings Similarly to many other mental disorders, generalized anxiety disorder has a substantial neurophysiological aspect to it. GAD is classified in the distress disorder group of anxiety disorders along with post-traumatic stress disorder due to its anticipatory nature; whereas anxiety disorders such as obsessive-compulsive disorder and panic disorder are classified as fear disorders because they are more so reactivity-based. The differentiation between the different

3 groups of anxiety disorders can be shown in functional MRI studies that “show different patterns of hyperactivation-inhibition in the structures of the extended fear circuit” (Gerez et al., 2016, p. 160). There has been a lot of research performed in regards to neurophysiology and anxiety disorders, and the various studies have yielded a great deal of significant results. Surface electroencephalogram (EEG) studies have shown that some people with anxiety disorders experience cerebral dysrhythmias and intracranial EEG studies have found that some panic attacks may be focal epileptic seizures (Gerez et al., 2016). It is clear that those with anxiety disorders do not only suffer psychologically, but also neurophysiologically. From studying both the brain and nervous system, three distinct types of dysfunction arise: “hyperactive (epileptic- like) neuronal populations, cortical instability, and misallocation of attentional resources” (Gerez et al., 2016, p. 161). However due to the complex nature of the brain and nervous system, it is unclear whether or not all of these types of dysfunction coexist or are separate entities. Therapeutic Interventions While anxiety disorders are becoming more prevalent in today’s society, they still remain under-recognized and under-treated. Nevertheless there are several therapeutic interventions that have been utilized to treat generalized anxiety disorder that generally produce positive results. Of the many therapy options, cognitive behavioral therapy (CBT) is often recognized as the most effective in the treatment of GAD. Utilizing CBT specifically for generalized anxiety disorder involves “the development of a functional analysis, providing information through psychoeducation, experimentation with new behaviors and emotions (exposition, relaxation), and a cognitive approach” (Borza, 2017). Functional analysis deals with determining how an anxious response is triggered whereas psychoeducation introduces different therapeutic tools to help promote positive change; introducing new emotions and behaviors as opposed to managing

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4 negative ones proves to be more effective, and the cognitive approach involves self-observation and modification (Borza, 2017). There are a few other types of therapies that can be used for generalized anxiety disorder if CBT is not available or isn’t proving to be effective. Supportive psychotherapy and psychodynamic therapy are the most common alternatives to CBT. Supportive psychotherapy places an emphasis on supporting one’s self-esteem by providing a safe environment where one can openly and comfortably talk about their experience with anxiety and the therapist “provides reassurance and encouragement” (DeMartini et al., 2019, p. 57). This type of therapy falls under the category of talk therapy and can provide patients’ with GAD an outlet to express their deepest thoughts and fears. Psychodynamic therapy on the other hand deals with resolving unconscious conflicts that stem from childhood or young adulthood relationships by utilizing techniques such as “clarifications, interpretations, and confrontations” (DeMartini et al., 2019, p. 57). This type of therapy more so tries to identify the root cause of anxiety so that it can be better understood and subsequently better managed. While both of these options can be helpful in managing GAD, CBT has remained the ideal option for treatment for several years. Contemporary Attitudes Towards Therapeutic Interventions With several different therapeutic interventions comes several different attitudes and opinions towards each intervention. As I said, cognitive behavioral therapy is typically the first choice of treatment for GAD likely due to the extensive studies that have helped prove its efficacy. However, there has been some doubt regarding the true recovery rate. “Only about 50% of patients achieve high-end state functioning or full recovery. (...) The aim is not to replace standard CBT treatment, but to provide a wider range of choices ( Bolognesi et al., 2014, p. 117). It appears that while CBT is generally favored by providers, others believe that it may not be a

5 sufficient long term solution to those who struggle with generalized anxiety disorder. Supportive psychotherapy has been considered by professionals as an “effective, brief, focal and interpersonal treatment for GAD” ( Bolognesi et al., 2014, p. 114). But while supportive psychotherapy does measure closely to CBT, there are some concerns relating to worry caused by GAD. It is thought that if supportive psychotherapy places a stronger emphasis on the process of worrying it would become a more optimal choice of treatment for generalized anxiety disorder ( Bolognesi et al., 2014). Psychodynamic therapy has been researched far less than CBT, but the research that has been done shows that it is as helpful as other approaches. In fact, a study completed in 2007 by Ferrero et al. claims that psychodynamic therapy “could effectively treat GAD both as a monotherapy and in combination with pharmacological treatment, with a reduction in anxiety and depressive symptoms maintained at 1-year follow-up” ( Bolognesi et al., 2014, p. 114). Overall all of these therapeutic intervention options are viewed by professionals with a generally positive attitude, of course they all have some room for improvement, but nonetheless they continue to be utilized for the treatment of generalized anxiety disorder. Final Thoughts and Conclusion Generalized anxiety disorder affects nearly seven million people in the United States alone. It is vital that psychological professionals continually work on improving the diagnostic and treatment process of GAD in order to help alleviate the many negative symptoms that come along with this disorder. If I had to choose an ideal approach for beginning to treat GAD based on research evidence, I would choose supportive psychotherapy. While CBT does work great for short term instances, supportive psychotherapy “emphasizes a positive therapeutic alliance as this is thought to provide a ‘corrective’ emotional experience, thus allowing the patient to deal

6 with feared situations, both psychologically and behaviourally ” ( Bolognesi et al., 2014, p. 114). From various personal experiences I have found that often people who struggle with mental health disorders really need someone to talk to about their issues in a nonjudgmental setting. This is not to discount other approaches that involve finding the roots of a problem, but rather a more helpful beginning in taking initiative to work on the symptoms one may deem as negative. It is important to have a positive rapport with one’s therapist, counselor, psychologist, etc. and supportive psychotherapy provides that. Nevertheless there is room for all types of therapeutic interventions when it comes to treating GAD as one size never fits all. In conclusion, generalized anxiety disorder needs to become more recognized and treated as it will benefit the population who experiences issues with the disorder. Resources

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7 Bolognesi, F., Baldwin, D. S., & Ruini, C. (2014). Psychological interventions in the treatment of generalized anxiety disorder: A structured review. Journal of Psychopathology, 20 (2), 111–126. Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience , 19 (2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of Internal Medicine , 170 (7). https://doi.org/10.7326/aitc201904020 Gerez, M., Suarez, E., Serrano, C., Castanedo, L., & Tello, A. (2016). The crossroads of anxiety: Distinct neurophysiological maps for different symptomatic groups. Neuropsychiatric Disease and Treatment , 159. https://doi.org/10.2147/ndt.s89651

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