- [Instructor] Now let's take a look
at Generalized Anxiety Disorder or GAD.
And this disorder is characterized
by excessive anxiety under most circumstances
and worry about practically anything.
GADs sometimes is what is also referred to
as free-floating anxiety.
It usually first appears in childhood or adolescence
and in fact it is quite common in the Western society.
Women tend to be diagnosed more than men
by about a ratio of two to one.
And about 1/4 of people who are diagnosed with this
are currently in treatment.
And there you see
the characteristics for GAD from the DSM-5.
For six months and more, the person experiences
disproportionate, uncontrollable,
and ongoing anxiety and worry about multiple matters.
The symptoms include at least three of the following.
Edginess, fatigue, poor concentration, irritability,
muscle tension, and sleep problems.
And there's significant distress or impairment
with the disorder.
And we know that there are a variety
of theoretical explanations to explain Generalized Anxiety,
so let's take a look at those theoretical explanations.
The first is the socio-cultural perspective,
which basically focuses
on societal and multicultural factors.
For this perspective, GAD is most likely to develop
in people faced with social conditions
that are truly dangerous.
Research supports this theory.
For example, when you take a look at situations like
nuclear disaster, the Three Mile Island in 1979,
Hurricane Katrina in 2005, the Haiti Earthquake in 2010,
we've found significantly higher rates of GAD.
A lot of the most powerful forms of societal stress
is poverty, and we find that those individuals
who face less equality, less power, greater vulnerability,
rundown communities, higher crime rates,
fewer educational and job opportunities,
are definitely at a greater risk for health problems.
And as would be predicted by this model then,
rates of GAD are generally higher
in lower socio-academic status groups.
However, while the poverty and other social pressures
may create a climate for GAD,
other factors are clearly at work.
And we find that quite honestly,
most people who're living in dangerous environments
don't actually develop GAD,
and other models will attempt to explain then
why some people develop the disorder and others do not,
such as this perspective, the psychodynamic perspective.
The psychodynamic perspective believe
that all children experience anxiety
and use defense mechanisms to help control it.
Realistic anxiety results from actual danger.
Neurotic anxiety, though, results when children
are prevented from expressing their id impulses.
So Freud believes then, that excessive childhood neurotic
or moral anxiety set the stage for GAD.
Contemporary theorists, however, often disagree
with very specific aspects of Freud's explanation,
though most continue to believe that the disorder
can be traced to an adequate parent-child relationships.
So when we take a look at the techniques
that are used or the therapies,
in general they use the same general techniques
for treating all dysfunctions.
So example free association, therapist's interpretation,
transference, resistance, dream analysis.
So those items that we had mentioned earlier
when we were taking a look
at some of the different approaches.
Specific treatment for GAD, the Freudians focus less
on the fear and more on the control of the id.
Object-Relations therapists attempt to help patients
identify and settle early-relationship problems.
Overall though, the research has shown
that the psychodynamic approaches
to be of only modest help in treating cases of GAD.
So now let's take a look at the humanistic perspective.
According to the humanistic perspective,
GAD arises when people stop looking at themselves
honestly and acceptingly.
And we have to look to Carl Rogers who again,
we first met when we talked about the humanistic approach,
but according to Carl Rogers,
the lack of unconditional positive regard in childhood
leads to harsh self-standards, known as conditions of worth.
These threatening self-judgments break through
and cause anxiety, setting the stage for GAD to develop.
Carl Rogers proposed client-centered therapy then
in which unconditional positive regard is given
to help the individual deal with anxiety.
The cognitive perspective believes
that psychological problems are caused
by dysfunctional ways of thinking,
in particular, excessive worry.
And very often, cognitive therapists will say
that someone who is dealing with GAD
is dealing with this because it's caused primarily
by maladaptive assumptions.
The person that we want associating
with this approach is Albert Ellis.
And he proposed that the presence
of these basic irrational assumptions
lead people to act in inappropriate ways
when these assumptions are relied on in everyday life.
Another theorist, Aaron Beck, argued
that those with Generalized Anxiety Disorder hold
unrealistic silent assumptions implying imminent danger.
And research does suggest or support the notion
that people with GAD do hold these maladaptive assumptions,
especially when they're facing situations
that are particularly dangerous.
Biological perspective then, believes
that GAD is caused primarily by biological factors.
And in particular, what we're gonna focus on
are the pedigree studies.
And in fact, the pedigree studies find
significant support for the biological approach.
Biological relatives are more likely to develop GAD,
about 15%, compared to the general population,
which is only approximately 6%.
And what we find is that the closer relative,
the greater the likelihood.
However, there is also some evidence or some indication
that shared-upbringing can contribute to having GAD.
Alright, when we take a look at the neurotransmitter GABA,
we find that GABA inactivity does contribute to it,
and may play a role in an individual developing GAD.
So when we take a look at the biology of anxiety,
we find that the circuit in the brain
that helps produce anxiety reactions,
includes areas such as the amygdala,
the prefrontal cortex, and the anterior cingulate cortex.
So in other words, what we are finding
is that there are definitely certain parts of the brain
that are impacting one's anxiety.
So when we take a look at treatment,
the anti-anxiety medications,
the pre-1950s treatments were primarily barbiturates.
Post-1950 treatments were Benzodiazepines,
and they provide temporary modest relief,
but they can cause rebound-anxiety with withdrawal
when you stop using them, and physical dependence,
we know, is definitely very possible.
In addition, Benzodiazepines
also have undesirable effects, such as drowsiness.
More recently, other medications have become available,
such as antidepressants and antipsychotic medications.
In addition, there is relaxation training,
in which someone learns to physically relax,
which will lead to psychological relaxation,
and in particular, on the use of biofeedback.
So with biofeedback,
there're electrical signals from the body
that are used to train people
to control their physiological responses.
The most widely used biofeedback tool
is this electromyograph or EMG,
which provides feedback about muscle tension.
The greatest impact is found when it is used
in combination with other medical treatments.
Alright, this mini lecture took a look
at Generalized Anxiety, the symptoms,
and the different theories,
as to what causes Generalized Anxiety.