Steve Jobs' 2005 Stanford Commencement Address

- [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.