Transcript Chapter 7: Self & Moral Development

Generalized Anxiety Disorder
Characteristics
 future-oriented mood state of anxious apprehension,
discouragement, being upset
 chronic tension
 Worry (common: family work, finances, illness)
 diffuse uneasiness
 Hypervigilance
 Avoidance (procrastination)
 Checking activities (e.g. calling a loved one)
 Difficulty making decisions
 Usually chronic, but not disabling
 Overuse health resources
 Often co-occurs with other anxiety and mood disorders
 Many experience occasional panic attacks
 May be associated with excessive use of tranquilizers, sleeping pills,
alcohol
 Attempts to control the worry often leads to increased experience of
intrusive thoughts and increased perception of inability to control
worries
Prevalence
1-year prevalence: 3%
Lifetime prevalence: 5.7%
Twice as common in women
Most common anxiety disorder in older
adults
Etiology - Psychological
 Chronic anxiety is evidence that defense mechanisms
were never developed or have broken down
 The experience of unpredictable and/or uncontrollable
events (e.g. history of trauma, parental
unresponsiveness or intrusiveness/overcontrolling)
 Low tolerance for uncertainty
 Lack of safety signals
 Cognitive biases for threatening information
The Benefits of Worry
 Perception of control
 Avoidance of deeper emotional topics
 Coping & preparation
 Worry is associated with the suppression of
related aversive emotional and physiological
responses, which results in not fully
processing/experiencing the topic being worried
about – this avoidance maintains the anxiety
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Etiology - Biological
Genetic predisposition (15 – 20% of the
variance) - GAD & MDD have a common
underlying genetic predispostion – part is
the basic personality trait “neuroticism”
Neurotransmitter & neurohormonal
abnormalities – deficiency of GABA;
serotonin & norepinephrine play a role;
stress hormones mediate GAD
Etiology - Sociocultural
Roles (e.g. gender) – do the gender
differences in prevalence reflect the
impact of role differences and differences
in treatment?
Race/ethnicity – does racism & prejudice
impact the experience of anxiety?
Community - our relationships are broken
as a result of sin and do not provide the
support needed to manage life well
Etiology - Spiritual
Biological vulnerabilities to
psychopathology reflect our fallen
condition
Our relationships reflect our fallen
condition
The way we think and feel reflect our fallen
condition
Spiritual (Y, B & M)
 “To be alive is to be anxious” – we often find
meaning & purpose in inauthentic life
philosophies (p. 109)
 The parable of the talents: anxiety & fear can
squelch responsibility, choice, and productivity
(p. 143) - Making sense of those things that
make us feel anxious, vulnerable or afraid, and
finding more effective ways to cope, is good
stewardship of talents” (p. 114)
Related Bible Verses
 "Therefore I tell you, do not worry about your life,
what you will eat or drink; or about your body,
what you will wear. Is not life more important
than food, and the body more important than
clothes? Look at the birds of the air; they do not
sow or reap or store away in barns, and yet your
heavenly Father feeds them. Are you not much
more valuable than they? Who of you by
worrying can add a single hour to his life?"
Matthew 6:25-27 New International Version
 "Cast your cares on the LORD and he will
sustain you; he will never let the righteous fall."
Psalm 55:22 NIV
"God is our refuge and strength, an everpresent help in trouble." Psalm 46:1 King
James Version
"Let not your heart be troubled: ye believe
in God, believe also in me." John 14:1 KJV
"Behold, God is my salvation; I will trust,
and not be afraid: for the LORD JEHOVAH
is my strength and my song; he also is
become my salvation." Isaiah 12:2 KJV
 "Come to me, all you who are weary and
burdened, and I will give you rest. Take my yoke
upon you and learn from me, for I am gentle and
humble in heart, and you will find rest for your
souls. For my yoke is easy and my burden is
light." Matthew 11:28-30 NIV
 "So do not worry about tomorrow; for tomorrow
will care for itself. Each day has enough trouble
of its own." Matthew 6:34 New American
Standard Bible
 "Even though I walk through the valley of the
shadow of death, I fear no evil, for You are with
me; Your rod and Your staff, they comfort me."
Psalm 23:4 KJV
 "I lift up my eyes to the hills— where does my
help come from? My help comes from the
LORD, the Maker of heaven and earth." Psalm
121:1-2 NIV
 "Trust in the Lord with all your heart; do not
depend on your own understanding.
 Seek his will in all you do, and he will show you
which path to take." Proverbs 3:5-6 New Living
Translation
 "An anxious heart weighs a man down, but a
kind word cheers him up." Proverbs 12:25 NIV
 We should be humble in our judgments and
respectful of our shared humanity (p.110– 111)
We differ in terms of our “raw material” & know
little about others’ acquired or inherited
vulnerabilities, therefore we should be cautious
about making moral judgments about character,
choice, and responsibility (p. 114).
Treatments
GAD Tends to be difficult to treat
 Medication – benzodiazepines, buspirone ,
antidepressants
 Cognitive-behavioral treatment (as successful as
medication)
- Progressive Muscle Relaxation & other relaxation
techniques(meditation, deep-breathing, biofeedback,
massage, etc.)
- cognitive restructuring (reduces distorted cognitions &
information processing biases; reduces
catastrophizing)
Healthy relationships are foundational for
mental health & spiritual well-being (p. 140
– Y, B & M) – we do not learn to cope well
and do not cope well without social
support
Lifestyle choices, including healthy diet,
exercise, rest
Criteria
A. Excessive anxiety and worry occurring more days than not for at least 6
months about a number of events or activities
B. Difficulty controlling the worry
C. Anxiety/worry associated with 3 or more of the following symptoms for a
majority of days:
1. restlessness or feeling keyed up
2. being easily fatigued
3. difficulty concentrating
4. irritability
5. muscle tension
6. sleep disturbance
D. Anxiety and worry not confined to features of another Axis I disorder
E. The symptoms cause clinically significant distress or impairment in functioning
Case Vignette
 A 39-year old married woman complains of being
irritable, “on-edge”, and restless most of the time for as
long as she can remember. She is frequently “snappy”
with her children and husband and has difficulty
concentrating at work. She is having difficulty sleeping
and is often tired during the day. She says that her
husband calls her a “worry wart” and admits that she
frequently worries about her job, finances, her kids, and
her own and family members’ health. She also worries
about her best friend’s safety and whether or not she is
doing a good job at her church ministry. She states that
she tries to not worry, but is unable to control her
worrying. She and her spouse reportedly have some
credit card debt and struggle to make ends meet. She
has diabetes, which although under control medically,
concerns her greatly.