Nicohwilliam

4-4aEtiology of Generalized Anxiety Disorder

GAD is the result of biological factors combined with psychosocial stressors, as shown in Figure 4.8. Let’s take a look at each of the factors that may contribute to the etiology of GAD.

Figure 4.8Multipath Model of Generalized Anxiety Disorder (GAD)

The dimensions interact with one another and combine in different ways to result in generalized anxiety disorder (GAD).

© Cengage Learning®

Biological Dimension

Heritability appears to play a small but significant role in the development of GAD (Kendler & Prescott, 2006). Genes associated with anxiety are often expressed in terms of neurotransmitter abnormalities or overactivity of brain regions associated with anxiety.

As mentioned earlier, our prefrontal cortex modulates our responses to threatening situations. GAD may involve a disruption in this system. In an MRI investigation, 18 adolescents with GAD and 15 without GAD were exposed to angry faces (Monk et al., 2006). Those with GAD showed greater activation of the prefrontal cortex in response to the faces, suggesting that the prefrontal cortex was attempting to regulate the anxiety aroused by the faces.

Did You Know?

A 2-year study of adolescents with GAD or social phobia revealed the following:

· GAD (but not social phobia) was associated with increased frequency of underage drinking.

· GAD symptoms preceded alcohol and cannabis use.

· Adolescents with social phobia used less alcohol and cannabis than those with GAD or no anxiety disorder.

Source: Frojd, Ranta, Kaltiala-Heino, & Marttunen, 2011

Psychological Dimension

Cognitive theories emphasize the role of dysfunctional thinking and beliefs in the development of GAD. Individuals with this disorder have a lower threshold for uncertainty, which leads to worrying. They also have erroneous beliefs regarding worry and assume that worry is an effective way to deal with problems or that it prevents negative outcomes from occurring (Ladouceur et al., 2000). A. T. Beck (1985) believes that negative  schemas  (mental frameworks for organizing and interpreting information) play a key role in anxiety disorders. Schemas may involve beliefs such as “I am incompetent” or “The world is dangerous.” When someone interprets everyday occurrences through the filter of a negative schema, ambiguous or even positive situations may be viewed with concern and apprehension.

Some researchers believe that the roots of GAD lie in beliefs regarding the function of worrying (A. Wells, 2005, 2009). In this model, there are two types of worry. The first involves the frequent use of worry to cope with stressful events or situations that might occur. However, the stress of constantly generating solutions to “what if” scenarios eventually results in a belief that worry is uncontrollable, harmful, and dangerous. GAD develops when the second type of worry (“worrying about worry”) occurs (D. M. Ellis & Hudson, 2010).

Social and Sociocultural Dimensions

A variety of social factors may influence the development of GAD. Mothers who themselves have anxiety symptoms may be less responsive and engaged with their infants than mothers who are not anxious. These behaviors appear to increase the likelihood that the child will develop GAD (A. Stein et al., 2012). Conflict in peer relationships, including being a victim of bullying, can increase the chances of developing GAD (Copeland, Wolpe, Angold & Costello, 2013). Stressful conditions such as poverty, poor housing, prejudice, and discrimination also contribute to GAD and may be responsible for the high prevalence of GAD in African Americans (Sibrava et al., 2013) and Latino/Hispanic Americans (Bjornsson et al., 2014).

4-4bTreatment of Generalized Anxiety Disorder

Benzodiazepines have been successful in treating GAD; however, because GAD is a chronic condition, drug dependence is a concern. Antidepressants are usually preferred because they do not have the potential for the physiological dependence seen with the benzodiazepines (NIMH, 2013a).

Cognitive-behavioral therapy (CBT) is an effective psychological treatment for GAD. A meta-analysis of CBT for GAD found it to be successful in reducing pathological worry; nearly 60 percent of those treated with CBT showed significant symptom reduction that continued 12 months after treatment (Hanrahan, Field, Jones, & Davey, 2013). This treatment generally involves teaching clients to (Stanley et al., 2003):

· identify worrisome thoughts;

· discriminate between worries that are helpful to problem solving and those that are not;

· evaluate beliefs concerning worry, including evidence for and against any distorted beliefs;

· develop self-control skills to monitor and challenge irrational thoughts and substitute more positive, coping thoughts; and

· use muscle relaxation to deal with somatic symptoms.

We now discuss another set of disorders characterized by persistent troublesome thoughts and underlying anxiety: obsessive-compulsive and related disorders.