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Abnormal Psychology
Generalized Anxiety Disorder (GAD)
Assignment 1


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Generalised Anxiety Disorder
We all worry about issues, to some extent, and for some its more beneficial than in
dealing with real-life challenges. When worry, however, becomes prevalent in our
daily activities to an extent where it becomes chronic and pathological it leads to
heightened levels of anxiety and distress. Worry is the principal diagnostic factor of
Generalised Anxiety Disorder (GAD). GAD is a common condition that exhibits a
sustained pattern of continuous worry or anxiety over assorted activities and issues,
even with little or no cause. A person with GAD would be aware of the worries and
fear and still have no control over their anxiety. The core symptoms of GAD are often
mistaken as personality traits in response to environmental and social stressors. The
sufferer will often only respond to seeking help after experiencing a comorbid
disorder such as depression, associated with GAD, The real presence of GAD will
then go undetected, and the focus will be more prevalent on the secondary comorbid
issue. Failure to identify GAD is a growing concern as chronic generalised anxiety is
associated with an increased risk in medical illness and a factor in the aetiology of a
wider range of other psychiatric disorders (Durham, 2004). This essay aims to
identify, contrast aetiology paradigms of GAD and demonstrate how GAD is
maintained and contrast different relevant interventions with recommendations on
how clinical approaches may select diverse treatment options.
GAD is more than the common evanescent moment of worry and labelling those who
worry as worry-warts. GAD sufferers experience the world as unsafe where bad
things happen for no reason (Connolly, 2006, p. 28). The epidemiology of worry is
seen as the essential factor of GAD in the Diagnostic Manual of Mental Disorders
(DSM-IV-TR; (American Psychiatric Association, 1994). Many of the results leading
to the diagnoses and assessment of GAD are found through empirical research on

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what people worry about, how often they encounter these worries and what happens
when they experience worry. Although these studies may not reflect true sample
representation, as many may experience worry in a limited milder and transient form
of an absence of anxiety, it is easy to see why GAD is not easily detected (Ruscio,
2002). However, studies have found that individuals who experience pathological
worry rate their worry more prevalent and difficult to control than those who do not
exhibit pathological worry (Davey & Wells, 2006). Comparing the worry rating criteria
of GAD on the DSM-IV-TR, where worry has had to be periodic for at least six
months with the new proposed DSM 5, to be constant for only three months, the
DSM-5 follows a more reliable diagnosis as people tend to experience a loss in
recalling the amount of anxiety and worry, longer than three months (Kring, Johnson,
Davison & Neale, 2012).
The framework of paradigms that postulate GAD is: the genetic paradigm- a
moderate heritability of the GAD disorder; the neurobiological paradigm which
suggests an abnormality in the brain (such as GABA deficits) and the cognitive
behavioural paradigm which focuses on the emotional and socio-cultural influences
on behaviour and mental processes (Kring et al., 2012).
GAD disorder developing through an integration of these paradigms (the nature,
development and treatment) is too diverse to be simplified by a single paradigm. The
diathesis-stress paradigm identifies and connects with genetic neurobiological
psychological and environmental influences. This paradigm focuses on the bias
tendency towards the disorder and psychological stressor such as past traumas and
deficits in the GABA system, inhibiting the neurotransmitter to decrease anxiety
(Kring et al., 2012). The diathesis-stress paradigm might suggest or support a multi

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paradigm intervention in treating GAD that will address predispositions and disorders
suggestive of a holistic pattern of health.
The genetic paradigm suggests that environmental influences such as stress,
culture, norms and beliefs influence and dominates our cognitive processes and
accordingly, our behaviour. Past studies have shown that childhood maltreatment
and abuse characteristic of this paradigm predicted a higher aetiology of GAD (Kring
et al., 2012). GAD suffers may avoid emotions, especially early life experiences such
as neglect or abuse or other traumatic experiences.
GAD, as cited in the diagnostic proposed DSM 5 criteria for generalised anxiety
disorder, may be a reduction in the emotions that elicit more intense emotions (Kring
et al., 2012). According to Skinner, positive reinforcement may lead to a decline in
behaviour associated with negative pressure or anxiety. Uncontrollable thoughts of
worry deprive people of pleasure and motivation or even the absence of it
(anhedonia) result in the avoidance or ambiguity of possible future occurrences
which lead to other anxiety disorders such as depression (Kring et al., 2012). If
researchers have identified worry as an avoidance of more intense emotions, could
this, then confirm why most behavioural techniques enforce calmness DeRubeis and
Crits-Christoph (as cited in Kring et al., 2012). According to Goosen (as cited in
Kring et al, 2012), changing negative self-statements and targeting emotional
directed coping approaches and concentrating on the present moment rather than
worrying, will address fears that have been avoided through worrying.
GAD is good according to researchers Parker, Hyett, Hadzi-Pavlovic, Brotchie and
Walsh (2011), but in a recent study by Martens et al. (as cited in Parker, et al.,
2011), it was found that GAD increased cardiovascular events by so much as 62%.

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They also concluded that more research should be done to determine the effect and
consequences of pharmacological and behavioural interventions used to reduce
anxiety thereby decreasing the chances of coronary artery disease. In a study done
by Parker et al. (2011), the researchers quantified that GAD was associated with a
superior cardiac one-year outcome (p. 383). The participants in this study
completed several self-report measures with emphasis on the Brief Measure of
Worry Severity measure. The results of the study (done over a five-year period)
showed that GAD to the most prevalent anxiety disorder. The results re GAD were
measured using the DSM-IV-TR (American Psychiatric Association, 1994).
The criteria for GAD symptoms can be categorised into key features of excessive,
uncontrollable worry about a number of incidents coinciding with at least three of the
correlated symptoms of negative physical and tension factors. Most of the studies
done in this essay were based on the DSM-IV-TR (American Psychiatric Association,
1994) criteria for GAD. The new proposed DSM-5 criterion for GAD differs in
specifying a shorter manifestation of GAD experienced by a person. In both the
DSM-IV-TR and DSM-5, the definition indicates an uncontrollable factor in worrying.
Although compared to other disorders, patients diagnosed with GAD noted with self-
perception scales on the content of worry about family matters, finances or other
issues, substantial distinction exists on self-perception measured scales reflecting
the controllability of the worry actions such as the frequency of unexpected worrying
and the percentage of times it happens per day.
Worry can be measured by trait questionnaires, and the most frequent used
questionnaires are the Penn State Worry Questionnaire (PSWQ) and the Worry
Domains Questionnaire (WDQ) Meyer, Miller, Metzger and Borkovec (as cited in
Verkuil et al., 2007). The PSWQ is used to measure the uncontrollable aspect of

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worry and as an outcome measure of the value of cognitive-behavioural therapies
used in the psychological treatment of GAD Borkovec and Costello (as cited in
Verkuil et al., 2007). In a study done by Verkuil, Brosschot and Thayer (2007), the
researchers found that night-time worry is often observed in GAD as well as
insomnia, which is believed to be prevalent in the aetiology in this disorder and the
PSWQ is a good predictor in the duration and the persistence of worry.
The key challenge in the prevention of an anxiety disorder, lies in the understanding
of the risk factors and vulnerability processes essential in the defining moment of the
development of anxiety disorder Schmidt and Zvolensky (as cited in Kring et al.,
2011).
According to researchers Gosselin and Laberge (2003), many studies suggest
environmental factors, negative life events (familial problems), childhood separation
and poor life satisfaction have been linked as aetiological factors contributing to
conceptualization of GAD. Other cognitive and behavioural approaches and studies
have been used to precise the aetiology of GAD and to point out a number of
variables such as attention deficit, false beliefs about worry and negative problem
orientation. All studies, however, lead to one suggestion that GAD is a result of
psychological vulnerability stimulated by tension derived from a negative occurrence
and thoughts (Gosseling & Laberge, 2003).
According to Durham (2004), there is no quick cure for long standing habits of
thoughts and behaviour that have maintained GAD. Wittchen (2002), suggested that
GAD may be a huge burden on society in terms of decreased work productivity and
increased health care utilization (p. 166). It is therefore, essential that the focus on
identification and acceptable treatment for anxiety disorder and improving the ability

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to recognise and treat GAD will help reduce the burden on both the individual and
society.
Cognitive Behavioural Therapy (CBT) is potentially a significant advantage to
psychological intervention. The strategies used in CBT are used to promote
calmness as the GAD sufferer is taught to relax rapidly. Added strategies to CBT are
aimed at altering automatic worrying thought and controlling the feelings of
uncertainty. A clinical psychologist presented with a patient suffering from GAD in a
cognitive behavioural paradigm, may choose to teach the individual to refocus their
thoughts and use self-help programs as a long-term management. As mentioned
before, some patients, however, may lack the motivation to becoming involved in
therapy
The symptomology of GAD is characterized by chronic worry and stress and are
often lifelong symptoms and are now seen as a public health problem (Durham,
2004). GAD can be identified and diagnosed quite soundly using the correct
measurement tools and establishing the presence of GAD even when other
symptoms of other disorders may also be present. GAD has a greater possibility in
developing another anxiety disorder than any other anxiety disorder Beesdo, Pine,
Lieb and Wittchen (as cited in Kring et al., 2012). The main difficulty, however, in
confirming GAD as a primary is comorbidity of other disorders.
Because of the comorbidity of GAD and depression some clinical psychologists
might prefer options of pharmacotherapy management for their patients. Patients
who find motivation for continuing Cognitive Behavioural Therapy (CBT) lacking, may
benefit from this a comorbid depression, linked to GAD, may alleviate both
anxiousness and depression through ant-depressant therapy (Durham, 2004).

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Abnormalities in the brain resulting in chemical imbalance and causing
neurotransmitters serotonin, high levels of norepinephrine and GABA to be involved
in anxiety disorders (Kring et al., 2012). The most frequent prescribed ant-
depressants are selective serotonin reuptake inhibitors (SSRIs). Pharmacotherapy
interventions seek to adjust and restore neurotransmitter activity to normal levels
(Kalat, 2007). According to Wittchen (2002), although anti-anxiety drugs may have
been used in the past with success, they are not ideal for the treatment of chronic
GAD. Clinical studies, however, have shown SSRIs are effective in the treatment of
GAD.
The diathesis-stress paradigm, however, does not limit treatment to a single school
of thought in addressing a cure for GAD (Kring et al., 2012, p. 58). This paradigm
links genetics, psychological and environmental factors to target the interaction
between the predisposition of the disease (diathesis) and lifes disturbances stress.
As a result, the diathesis-stress paradigm favours an accommodative approach
incorporating all viable interventions for the treatment of GAD.
Diagnosis for generalized anxiety disorder is not as simple as a just a quick
evaluation whether the patient has at least three of the six symptoms on the DSM-IV-
TR or the newly proposed DSM-5 but it requires the psychologist to assess all
approaches, paradigms and factors to assist those diagnosed with GAD to address
the core components namely excessive and uncontrollable worry. The DSM-5
however will narrow the chances of a much earlier assessment of GAD than its
predecessor and hopefully bring a speedier recovery to the sufferer.



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References
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of
Mental Disorders (4
th
ed.). Washington, DC: APA

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Connolly, S., Simpson, D., Petty, C. (2006). Anxiety Disorders. New York: Infobase
Publishing
Durham, R. C. (2004). Treatment of generalized anxiety disorder. Psychiatry, 3(4),
30-34. doi:10.1383/psyt.3.4.30.32903

Gosselin, P., & Laberge, B. (2003). Etiology factors of generalized anxiety disorder.
Ecole de psychologie, Universite Laval. Quebec. Canada. Retrieved from
http://ncbi.nlm.nih.gov/pubmed/14615705[7/14/2012 5:16:52 PM]
Kalat, J. W. (2009). Biological Psychology. (10
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Kring, A. M., Johnson, S. L., Davison, G., & Neal, J. (2012). Abnormal Psychology.
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Parker, G., Hyett, M., Hadzi-Pavlovic, D., Brotchie, H. & Walsh, W. (2011). GAD is
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differentiating high worriers with and without GAD. Journal of Anxiety
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Verkuil, B., Brosschot, J. F., Thayer, J. F. (2007). Capturing worry in daily life: Are
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Wittchen, H. (2002). Generalized anxiety disorder: prevalence, burden, and cost to
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