Generalized Anxiety Disorder

Brittany SmithWake Forest University Fall 2012

October 29, 2012

• Affects psychological health, causes physiological effects, and diminishes the overall quality of life

• Characterized by excessive worrying, somatic symptoms

• Lifetime prevalence rate of 5% • GAD is undertreated, misdiagnosed (sometimes mistaken for hypochondriasis, panic disorder, dysthymic disorder)

Background Information

Methods Z. Smith Reynolds Library website Narrowed down topics

• Diagnosis/comorbidity• Assessment• Psychotherapy (originally looked at “treatment”, which

included research about pharmacological treatments as well)

Journals used: Journal of Clinical Psychiatry, Journal of Consulting and Clinical Psychology, American Journal of Psychiatry

Key search terms: • “Generalized Anxiety Disorder and CBT”• “Effects of Psychotherapy in GAD”• “Comorbidity in Generalized Anxiety Disorder”

Diagnosis Diagnosing this disorder can be difficult because of the following issues:

• Physiological symptoms that people experience are often thought to be the result of medical conditions, not GAD

• GAD has undergone different changes in its diagnostic criteria

• Great variability in the reporting of GAD symptoms

• The diagnostic threshold is ambiguous• GAD has a very high comorbidity rate with other

anxiety disorders, Bipolar Disorder, substance abuse disorders, and Major Depressive Disorder (symptoms overlap)

General Anxiety Disorder: “The Comorbid Disorder”

Approximately 90% of individuals with Generalized Anxiety Disorder also have another coexisting condition (Simon, 2009)

Nearly 2/3 of these people have Major Depressive Disorder

High rates of comorbidity with Substance Use Disorder

Alcohol consumption leads to heightened anxiety levels, as a result of hyperexcitability of the autonomic nervous system (Brady, Tolliver, Verduin, 2007)

Diagnosing coexisting GAD and SUD can be difficult because symptoms of GAD overlap with alcohol withdrawal symptoms

Assessment tools The HARS (HAM-A) is a

clinician rated measure that assesses the intensity of anxiety symptoms

BAI focuses on somatic symptoms of anxiety. This inventory was created as a measure to distinguish anxiety symptoms apart from those associated with depression.

The STAI is commonly used in clinical environments to diagnose anxiety, as well as to differentiate it from depressive syndromes

Psychotherapeutic Treatment Cognitive Behavioral Therapy (CBT) is currently

considered to be most effective (some sources report that CBT in conjunction with medicinal treatment is efficacious)

Study comparing CBT and AR showed that though CBT and AR were highly effective, change in worry led to change in somatic anxiety to a greater extent in CBT than in AR (Donegan & Dugas, 2012)

Study comparing long term effects of Short term Psychodynamic Therapy (STPP) and CBT found both to be effective, but CBT was superior (Salzer, Winkelbach, Leweke, Leibing, Leichsenring, (2011)

Further research should be done on other treatments

ConclusionOverall lack of research available

on GAD, in comparison to other anxiety disorders

Diagnostic criteria may change in DSM V to help mitigate the issue with comorbidity

Long term effects of psychotherapy should be observed more in future research

Resources Brady, M. D., Tolliver, M. D., & Verduin, M. D. (2007). Alcohol use and anxiety:

Diagnostic and management issues. American Journal of Psychiatry, 164(2), 217–221.

Donegan, E., & Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology. doi:10.1037/a0028132

Portman, M. E., Starcevic, V., & Beck, A. T. (2011). Challenges in assessment and diagnosis of generalized anxiety disorder. Psychiatric Annals, 41(2), 79–85. doi:http://dx.doi.org.go.libproxy.wfubmc.edu/10.3928/00485713-20110203-06

Salzer, S., Winkelbach, C., Leweke, F., Leibing, E., & Leichsenring, F. (2011). Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-Month Follow-up. Canadian Journal of Psychiatry, 56(8), 503–8.

Simon, N. (2009). Generalized anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse. Journal of Clinical Psychiatry, 70(2), 10-14.

http://totalpict.com/anxiety%20rating%20scale