WEBVTT

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- [Instructor] Now let's take a look

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at Generalized Anxiety Disorder or GAD.

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And this disorder is characterized

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by excessive anxiety
under most circumstances

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and worry about practically anything.

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GADs sometimes is what is also referred to

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as free-floating anxiety.

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It usually first appears
in childhood or adolescence

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and in fact it is quite
common in the Western society.

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Women tend to be diagnosed more than men

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by about a ratio of two to one.

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And about 1/4 of people
who are diagnosed with this

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are currently in treatment.

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And there you see

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the characteristics
for GAD from the DSM-5.

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For six months and more,
the person experiences

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disproportionate, uncontrollable,

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and ongoing anxiety and
worry about multiple matters.

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The symptoms include at
least three of the following.

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Edginess, fatigue, poor
concentration, irritability,

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muscle tension, and sleep problems.

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And there's significant
distress or impairment

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with the disorder.

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And we know that there are a variety

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of theoretical explanations to
explain Generalized Anxiety,

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so let's take a look at those
theoretical explanations.

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The first is the
socio-cultural perspective,

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which basically focuses

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on societal and multicultural factors.

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For this perspective, GAD
is most likely to develop

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in people faced with social conditions

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that are truly dangerous.

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Research supports this theory.

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For example, when you take
a look at situations like

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nuclear disaster, the
Three Mile Island in 1979,

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Hurricane Katrina in 2005,
the Haiti Earthquake in 2010,

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we've found significantly
higher rates of GAD.

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A lot of the most powerful
forms of societal stress

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is poverty, and we find
that those individuals

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who face less equality, less
power, greater vulnerability,

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rundown communities, higher crime rates,

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fewer educational and job opportunities,

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are definitely at a greater
risk for health problems.

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And as would be predicted
by this model then,

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rates of GAD are generally higher

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in lower socio-academic status groups.

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However, while the poverty
and other social pressures

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may create a climate for GAD,

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other factors are clearly at work.

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And we find that quite honestly,

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most people who're living
in dangerous environments

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don't actually develop GAD,

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and other models will
attempt to explain then

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why some people develop the
disorder and others do not,

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such as this perspective, the
psychodynamic perspective.

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The psychodynamic perspective believe

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that all children experience anxiety

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and use defense mechanisms
to help control it.

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Realistic anxiety results
from actual danger.

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Neurotic anxiety, though,
results when children

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are prevented from
expressing their id impulses.

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So Freud believes then, that
excessive childhood neurotic

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or moral anxiety set the stage for GAD.

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Contemporary theorists,
however, often disagree

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with very specific aspects
of Freud's explanation,

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though most continue to
believe that the disorder

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can be traced to an adequate
parent-child relationships.

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So when we take a look at the techniques

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that are used or the therapies,

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in general they use the
same general techniques

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for treating all dysfunctions.

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So example free association,
therapist's interpretation,

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transference, resistance, dream analysis.

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So those items that we
had mentioned earlier

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when we were taking a look

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at some of the different approaches.

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Specific treatment for GAD,
the Freudians focus less

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on the fear and more on
the control of the id.

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Object-Relations therapists
attempt to help patients

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identify and settle
early-relationship problems.

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Overall though, the research has shown

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that the psychodynamic approaches

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to be of only modest help
in treating cases of GAD.

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So now let's take a look at
the humanistic perspective.

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According to the humanistic perspective,

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GAD arises when people
stop looking at themselves

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honestly and acceptingly.

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And we have to look to
Carl Rogers who again,

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we first met when we talked
about the humanistic approach,

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but according to Carl Rogers,

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the lack of unconditional
positive regard in childhood

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leads to harsh self-standards,
known as conditions of worth.

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These threatening
self-judgments break through

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and cause anxiety, setting
the stage for GAD to develop.

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Carl Rogers proposed
client-centered therapy then

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in which unconditional
positive regard is given

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to help the individual deal with anxiety.

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The cognitive perspective believes

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that psychological problems are caused

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by dysfunctional ways of thinking,

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in particular, excessive worry.

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And very often, cognitive
therapists will say

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that someone who is dealing with GAD

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is dealing with this because
it's caused primarily

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by maladaptive assumptions.

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The person that we want associating

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with this approach is Albert Ellis.

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And he proposed that the presence

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of these basic irrational assumptions

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lead people to act in inappropriate ways

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when these assumptions are
relied on in everyday life.

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Another theorist, Aaron Beck, argued

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that those with Generalized
Anxiety Disorder hold

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unrealistic silent assumptions
implying imminent danger.

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And research does suggest
or support the notion

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that people with GAD do hold
these maladaptive assumptions,

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especially when they're facing situations

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that are particularly dangerous.

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Biological perspective then, believes

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that GAD is caused primarily
by biological factors.

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And in particular, what
we're gonna focus on

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are the pedigree studies.

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And in fact, the pedigree studies find

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significant support for
the biological approach.

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Biological relatives are
more likely to develop GAD,

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about 15%, compared to
the general population,

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which is only approximately 6%.

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And what we find is that
the closer relative,

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the greater the likelihood.

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However, there is also some
evidence or some indication

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that shared-upbringing can
contribute to having GAD.

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Alright, when we take a look
at the neurotransmitter GABA,

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we find that GABA inactivity
does contribute to it,

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and may play a role in an
individual developing GAD.

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So when we take a look at
the biology of anxiety,

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we find that the circuit in the brain

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that helps produce anxiety reactions,

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includes areas such as the amygdala,

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the prefrontal cortex, and
the anterior cingulate cortex.

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So in other words, what we are finding

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is that there are definitely
certain parts of the brain

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that are impacting one's anxiety.

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So when we take a look at treatment,

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the anti-anxiety medications,

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the pre-1950s treatments
were primarily barbiturates.

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Post-1950 treatments were Benzodiazepines,

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and they provide temporary modest relief,

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but they can cause
rebound-anxiety with withdrawal

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when you stop using them,
and physical dependence,

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we know, is definitely very possible.

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In addition, Benzodiazepines

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also have undesirable
effects, such as drowsiness.

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More recently, other medications
have become available,

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such as antidepressants and
antipsychotic medications.

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In addition, there is relaxation training,

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in which someone learns
to physically relax,

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which will lead to
psychological relaxation,

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and in particular, on
the use of biofeedback.

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So with biofeedback,

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there're electrical signals from the body

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that are used to train people

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to control their physiological responses.

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The most widely used biofeedback tool

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is this electromyograph or EMG,

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which provides feedback
about muscle tension.

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The greatest impact is
found when it is used

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in combination with
other medical treatments.

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Alright, this mini lecture took a look

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at Generalized Anxiety, the symptoms,

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and the different theories,

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as to what causes Generalized Anxiety.