Table of Contents
Abstract
Joe is in excellent health and has great company benefits which include medical insurance, dental insurance, and retirement benefits. He is happily married, employed at a successful company, is valued and is progressively climbing up the corporate ladder. Joe also has two kids, who are doing well academically, they are loving, respectful kids, and do not get into any type of trouble. Joe makes enough money that his wife does not have to work, has money in the bank, a great savings plan, a lovely home, and lives in a safe and clean neighborhood. He is in great health, with no complicating medical conditions, considered to be very attractive, in addition, to being well-liked easy to get along with, and well-liked by everyone.
However, Joe is continuously seen as anxious about current events, continuously displays signs of nervousness, restlessness, and appears to be constantly stressed, and apprehensive about upcoming events. Individuals, such as Joe, “diligently displays signs of the anxiety of issues which are believed to disturbing to them and cause them to become unfortunately worried and become anxious” (Hooley, 2017). These individuals who have revealed these comprehensive methods of behavior are diagnosed with a specific type of anxiety syndrome documented as generalized anxiety disorder (GAD).
For this paper, this diagnostic presentation will briefly address the epidemiology of GAD in Americans to include: theoretical orientations, the outcome of a brief case study, definitional material, signs, symptoms and criteria to diagnosis GAD, risk factors, treatments, régimes, outlooks, , the effects of cognitive behavior therapy and diverse therapy treatments, pharmacological therapy, cognitive behavioral therapy versus component death anxiety and its role in psychopathology, and a brief summarized case study associated with GAD.
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Generalized Anxiety Disorder
Anxiety is the fear of experiencing horror or dismay in the future. The risk that is dreaded, is not generally imminent, and the fear also may not be recognized or realistic to others. In contrast, naturally fear is an expressive and carnal reaction to a present, known threat. Anxiety is recognized as being both a psychological and physical experience. Therefore GAD may develop gradually and often starts during the teen years or as a young adult and women are two times more likely to be affected. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. Although the exact cause of GAD is unknown, there is evidence that biological factors, family background, and life experiences, particularly stressful ones, play a role. Anxiety and worry are interrelated with at least three physical or the cognitive symptoms of GAD (Hooley, 2017).
Signs, Symptoms, and Criteria for Diagnosis
Currently, GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any specified year. GAD is one of the most common anxiety disorders in adults. “Epidemiological surveys estimate the lifetime prevalence of GAD at 2.8–6.2% and the 12 month prevalence at 0.2–4.3% In the National Comorbidity Replication Survey, the 12-month prevalence of GAD was approximately 12% in adults over the age of 55 years” (Boswell, 2013). Dimensional and structural diagnoses have each been used in the clinical treatment and research, in which both methods are projected for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). Though, each of these methods has restrictions more recently, the prominence in diagnosis has focused on neuroimaging and inherent research. “This approach is constructed moderately on the need for a more complete understanding of how biology, stress, and inheritances correlate to profile the symptoms of anxiety” (Bystritsky, 2013).
From time to time just the thought of getting through the day produces anxiety for people with GAD. They do not know how to stop the fear or the worrying and sense it is beyond their control. This is even though they often understand that their anxiety is more self-motivated than the state of affairs or circumstances they are in. As with all anxiety disorders, GAD will relate to the inability to tolerate any type of uncertainty a person has in their life and therefore many people with GAD try to preplan or control situations. When individual with GAD illustrate mild to moderate levels of anxiety, or are treated, they can function on a social basis, have productive and lucrative lives, and continue to be gainfully employed. Many individuals with GAD may avoid circumstances because of this disorder or they may not take advantage of potential prospects and opportunities due to their worrying. Some of these people with GAD have difficulty carrying out the simplest daily activities when their anxiety is severe.
A person with GAD often worries more than not and in most cases people with GAD are considered to have excessive worrying. Individuals diagnosed with excessively worrying means the person is worrying even when there is nothing wrong or in a manner that is inconsistent with the actual thought that makes them worry. This characteristically involves expending a high proportion of waking hours worrying about something they perceive to be an issue. This excessive unrealistic worry can become terrifying and can hinder relationships and daily activities.
Many individuals diagnosed with GAD, have anxiety, worry, or demonstrate associated warning sign which also makes it difficult to carry out day-to-day actions and responsibilities. This disorder may cause complications in relationships, which can be at work, or in other important areas. The symptoms will also be dissimilar to any other medical situations and cannot be explained by the effect of substances to include prescription medications, alcohol, recreational drugs or symptoms explained by another mental disorder. However, the need to pursue reassurance-seeking from others is also an effect of the symptoms of worrying.
In adults, worrying can result in a person’s apprehension of job responsibilities or performance, health or the health of family members, financial matters, and other everyday, typical life situations. This worrying has also been diagnosed with an experience which is very challenging to control. Worrying in both adults and children may alternate from one issue to another. Similarly, in children, the worry is more probable to be about their abilities or the value of their performance, which could be in school, or sports.
Nevertheless, there is a mutual theme, which is the ability to inhibit and halt a person from living a standard and regular or normal life. Sometimes people with GAD just worry, but they are unable to say what they are worried about. They tend to report that in their emotional state of mind, that something wicked or immortal may occur or might report that they just cannot make themselves at peace or tranquil. However, most symptoms of GAD are considered to be philosophical and diverse in nature, which may confirm why there are a lot of people who believe worry prevents bad or corrupt issues or situations from occurring so, they view it as risky to give up worrying.
Some of the common physical indications associated with GAD are comprised of prominently strong or rapid heartbeats, extreme sweating, muscle tension, or difficulty concentrating or sleeping. Individuals will also show signs of irritability, fatigue, exhaustion, repeated stomach aches or diarrhea, shaking, and sweaty palms. The symptoms begin as a person starts to endure occurrences of chest pains and experiencing the shortage of breath. These symptoms may get better or worse at various times, and they are often worse during times of stress, and strain, such as with a physical illness, during exams at school, or during a family or relationship issue. Some of these individuals during these times experience symptoms such as sweating, nausea, or diarrhea.
Treatments
Anxiety disorders can be effectively treated with psychopharmacological and cognitive behavioral interventions. These interventions have different symptom targets; thus, rational combinations of these methods need to be further studied in order to improve future outcomes. “New developments are forthcoming in the field of substitute strategies for managing anxiety and for treatment-resistant cases. Other treatment should consist of the development of algorithms that can be easily used in primary care and with a greater focus on managing functional impairment in patients with anxiety” (Bystritsky, 2013).
Cognitive-Behavioral Therapy Intervention
Cognitive behavioral therapy (CBT) Meta-analysis which is used as a statistical approach to combine the results from multiple studies in an effort to increase control and, improve estimates of the size of the effect of individual studies and research of various forms of literature on the treatment outcomes of CBT. This would cover an extensive range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically demanding meta-analyses being conducted. For the analysis, the focuses were on the effect sizes that and the distinctive outcomes for CBT.
This provided the outcomes for several control groups designed for each disorder. It also provided a synopsis of the efficiency of cognitive therapy due to being computed by meta-analysis. Large effect sizes were made available for CBT for diverse disorders such as unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, and posttraumatic stress disorder. In addition to including disorders such as childhood depressive and other anxiety disorders to include effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression.
CBT was also found to be similarly effective for behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Also, large uninhibited effect sizes were found for bulimia nervosa and schizophrenia. “Therefore the meta-analyses supported the effectiveness of CBT for many disorders. While limitations of the meta-analytic approach need to be considered when inferring the results, the conclusions were consistent with the supplementary assessment methodologies which also provided provisions for the efficacy of CBT” (Butler, 2005).
GAD Calculated Through Theory Rather Than Experience or Practice
The intolerance of uncertainty (IU) is a characteristic associated with GAD. However, evidence indicates that IU may be a communal component of emotional disorders since during “the study of transdiagnostic treatment, and the relationship between change in IU and treatment outcome, patients diagnosed with a form of assorted anxieties and depressive disorders received up to 18 weeks of a transdiagnostic cognitive-behavioral therapy intervention. Patient were permitted to self-reported IU and clinician-rated symptoms and/or operational measures were administered at pretreatment and posttreatment.
While utilizing regulatory measures for negative affectivity, IU correlated with the trials of depressive symptoms and worry severity at pretreatment. Patients with GAD and anxiety disorder displayed the topmost pretreatment IU scores, nevertheless IU scores failed to fluctuate suggestively supported the existence or absence of a particular identification. A considerable decrease in IU was ascertained, and also the modification in IU was related to condensed anxiety and depressive symptom levels at posttreatment across diagnostic groupings. Subsequently, the variation in IU is often detected across downside areas in transdiagnostic treatment and such a modification is related to operative treatment outcome” (Boswell, 2013).
Prevalence and Incidences of Anxiety Disorders in the General Population
Anxiety disorders effect up to 13.3% of individuals in the U.S. and institute the most predominant subcategory of mental disorders. The degree of their prevalence was first revealed in the Epidemiological Catchments Area study about 26 years ago. Regardless of their widespread prevalence, these disorders have not established the same acknowledgment as other major syndromes such as temperament and psychotic disorders. In addition, the primary care physician is usually the assessor and treatment provider. “Because of this management environment, anxiety disorders can be said to account for diminished efficiency, amplified morbidity and mortality rates, and the development of alcohol and drug abuse in a large sector of the population” (Bystritsky, 2013).
Challenges of a Diagnosis of GAD
Despite the difficulties in diagnosing GAD it can be distinguished from similar disorders and anxieties. Due to this difficulty it has made a few individuals in the field of diagnosing mental disorders to suggest that a dimensional model may be used for not only the study but the treatment of GAD. This disorder is seen through a combination of symptoms such as panic, social ineptness, and obsessiveness. Each of these symptoms will and must be look into either through theoretical, biological, or genetic factors, which can dictate treatment methods. Some of the methods used to determine a diagnoses is debatable and still are not introduced into the DSM-5.
Case Study GAD Treatment
In trying to find an integrative treatment for GAD by merging cognitive-behavioral therapy, empirically supported treatment, and interpersonal-emotional processing therapy we found that the that the subject dropped out of treatment after the 8th session. In this research case, the treatment was intended to improve upon the efficiency of the standard treatment. Though, one of the goals was for the clinicians and researchers to share what they had discovered to advance treatments. Not all of these approaches, however, work well for every client. This may be due to the fact that “in the quest of the ultimate goal of assisting clients to make positive changes, more data needs to be acquired by reviewing cases of failures, in the same manner that successful treatments are studied” (Boswell, 2011).
It was discovered that using the response and nonresponse answers showed that there was support for empirically supported treatments (ESTs). But this to has its issues since researchers have their own descriptions and classifications, often using diverse outcome measures. For example, one way to define response is to examine effect size, yet even these tend to vary from study to study. Nevertheless, “meta-analyses suggest that, on average, about 50% of clients with GAD accomplish high end state functioning. In the present case, we have defined nonresponse by premature, unilateral termination. As such, we have conceptualized this as a case for whom the treatment failed because it did not provide her with an opportunity to receive full benefit” (Boswell, 2011).
References
- Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders. Journal of Clinical Psychology, 69(6), 630-645. doi:10.1002/jclp.21965
- Boswell, J. F., Llera, S. J., Newman, M. G., & Castonguay, L. G. (2011). A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder. Cognitive and Behavioral Practice, 18(3), 326-337. doi:10.1016/j.cbpra.2010.09.001
- Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The Empirical Status of Cognitive-Behavioral Therapy: A Review of Meta-Analyses. Clinical Psychology Review, 26(1), 17-31. doi:10.1016/j.cpr.2005.07.003
- Hooley, J. M., Butcher, J. N., Nock, M. K., & Mineka, S. (2017). Abnormal psychology (17th ed.). Boston, MA: Pearson.
