GGZ2024 – ANXIETY AND RELATED
DISORDERS
SUMMARY OF ALL LITERATURE
A L L T AS K S + L E C T U R E S
, GGZ2024 – TASK 1
GOAL 1: WHAT ARE THE SYMPTOMS OF GENERALIZED ANXIETY DISORDER?
Generalized Anxiety disorder:
1. Anxiety and worry >6 months
2. Difficult to control worry
3. 3 or more symptoms:
a. Relestness
b. Fatigued
c. Bad concentration
d. Irritatibility
e. Muscle tension
f. Sleep disturbance
4. Clinically distress/impairment
5. Not beause of substance/physiological effects
6. Not explained by other disorder
GAD Worrying as coping (positive metacognitive beliefs about worrying) and development of
negative beliefs about worry and negative appraisal of worry (meta-worry).
Type 1 worry: About external events, catastrophizing sequences of thoughts
Type 2 worry: About thoughts themselves and uncontrollability ( E.G.I should not worry, if I don’t stop I’ll get
a heartattack). Stronger predictor of pathological worry than type 1,
,Trigger: exam
Positive belief: I studied hard.
Worry 1: what if I won’t pass?
Negative belief: what if I skipped something?
Worry 2: I should not overthink it, I don’t pass, I don’t get my bachelor etc.
Type 2 worry: 2 feedback cycles:
1. Reassurance seeking or avoidance of cues that trigger worry, maintain negative beliefs about
danger and uncontrollability of worry.
2. Thought control strategies (suppression of thoughts that trigger worry. increase thought
intrusions and reinforce beliefs about uncontrollability of worry.
Some strategies increase worry triggers: GAD patient doesn’t encounter evidence that disconfirm
negative beliefs and type 2 worries.
Meta beliefs = knowledge produces by affective reasoning processes
Positive metacognitive beliefs = adaptive metacognitive beliefs regarding cognitive and emotional
process one may face in challenging situations (e.g. If I worry I’ll be prepared or worrying helps me cope
benefits of worry)
Negative meta-beliefs = negative beliefs about uncontrollability of thoughts ( e.g. I could make myself sick
with worrying or I have poor memory ) or about the need to control thoughts ( e.g. ‘If I did not control a worrying
thought, and then it happened, it would be my fault’)
GAD patients report higher scores on negative metacognitions concerning worry than patients with
social phobia, panic disorder or non-patient controls.
Formulating GAD mechanisms:
1. Attempts to interrupt type 1 worry
2. Suppress/remove thought triggering worrying from consciousness (rarely effective)
3. Lack of attempts to interrupt type 1 worry reduces opportunities to discover worrying is
subject to coluntary control.
People engage more in trying to remove the content of type 1 worry triggers from awareness than
interrupting the worry process.
Conclusions:
- GAD patients have higher negative beliefs about uncontrollability and danger than other
people
- No difference in endorsement of positive metacognitive beliefs between GAD and other
people
- GAD patients report higher type 2 worries than other people.
- Differences in negative metacognitions are independent of Type 1 worry in the case of
negative beliefs concerning uncontrollability and danger.
Key symptom of GAD Worry defined as ‘apprehensive expectation’, repetitive thinking about
potential future threats, imagined catastrophes, uncertainties and risks, or thoughts, images which
are negatively affect and relatively uncontrollable.
, Source: Wells and Carter (2001)
Anxious people are highly alert/ aroused and in a state of ‘overpreparedness’ and hyperarousal
seems to be chronic.
Research: Heartrate for agoraphobia patients was way higher at each walk than of controls.
However, heartrate decreased/habituated in both groups over the 7 walks. Difference was the
increase in heartrate in the final walk in agoraphobia patients final exam effect.
Data shows no difference between the 2 groups in heartrate during frightening (for patients) walk,
relative to the heartrate on baseline measurements days.
- Patients are chronically overaroused and have a chronically high and labile heartrate
compared to controls.
Harmonic driving is higher in anxious patients than in non-anxious controls or depressed patients
(more beta activity and less alpha activity).
- Habituations of GSR (galvanic skin response) was much slower in patients than controls.
Normal controls and specific phobia patients both habituated quickly and had fewer spontaneous
fluctions (not the same overarousal). Social and agoraphobia with depression were chronically
overprepared.
GAD patients increased heartrate and less heartrate variability. Worrying is directly associated
with lowered parasympathetic control of cardiovascular functioning automatic inflexibility in
GAD.
Cognitive behavioural therapy→showed significant increases in heart rate variability and
parasympathetic tone.
Borkovec autonomic inflexibility in anxious patients is related to the fact feared stimuli are not
produced by external environmental stressors, but are (chronically present) internally generated
thoughts about potential future threats.
Furthermore, autonomic inflexibility seems to be a characteristic of anxiety disorders in general,
rather than a psychophysiological feature associated with just one disorder (for example it has been
noted in patients with panic disorder and OCD as well as GAD).
Source: Barlow (2002).
GOAL 2: WHAT ARE THE SYMPTOMS OF SOCIAL ANXIETY DISORDER?
Social Anxiety Disorder (social phobia):
A. Fear or anxiety about 1 or more social situations
a. Fear of acting a way/showing anxiety and being negatively evaluated
b. Social situations almost always provoke fear/anxiety
c. Social situations are avoided or endured within tense fear/anxiety
d. Fear/anxiety is out of proportion to actual threat
e. Persistent (>6 months)
f. Clinically significant distress/impairment
g. Not because of physiological effects or substance
h. Not because of other mental disorder
DISORDERS
SUMMARY OF ALL LITERATURE
A L L T AS K S + L E C T U R E S
, GGZ2024 – TASK 1
GOAL 1: WHAT ARE THE SYMPTOMS OF GENERALIZED ANXIETY DISORDER?
Generalized Anxiety disorder:
1. Anxiety and worry >6 months
2. Difficult to control worry
3. 3 or more symptoms:
a. Relestness
b. Fatigued
c. Bad concentration
d. Irritatibility
e. Muscle tension
f. Sleep disturbance
4. Clinically distress/impairment
5. Not beause of substance/physiological effects
6. Not explained by other disorder
GAD Worrying as coping (positive metacognitive beliefs about worrying) and development of
negative beliefs about worry and negative appraisal of worry (meta-worry).
Type 1 worry: About external events, catastrophizing sequences of thoughts
Type 2 worry: About thoughts themselves and uncontrollability ( E.G.I should not worry, if I don’t stop I’ll get
a heartattack). Stronger predictor of pathological worry than type 1,
,Trigger: exam
Positive belief: I studied hard.
Worry 1: what if I won’t pass?
Negative belief: what if I skipped something?
Worry 2: I should not overthink it, I don’t pass, I don’t get my bachelor etc.
Type 2 worry: 2 feedback cycles:
1. Reassurance seeking or avoidance of cues that trigger worry, maintain negative beliefs about
danger and uncontrollability of worry.
2. Thought control strategies (suppression of thoughts that trigger worry. increase thought
intrusions and reinforce beliefs about uncontrollability of worry.
Some strategies increase worry triggers: GAD patient doesn’t encounter evidence that disconfirm
negative beliefs and type 2 worries.
Meta beliefs = knowledge produces by affective reasoning processes
Positive metacognitive beliefs = adaptive metacognitive beliefs regarding cognitive and emotional
process one may face in challenging situations (e.g. If I worry I’ll be prepared or worrying helps me cope
benefits of worry)
Negative meta-beliefs = negative beliefs about uncontrollability of thoughts ( e.g. I could make myself sick
with worrying or I have poor memory ) or about the need to control thoughts ( e.g. ‘If I did not control a worrying
thought, and then it happened, it would be my fault’)
GAD patients report higher scores on negative metacognitions concerning worry than patients with
social phobia, panic disorder or non-patient controls.
Formulating GAD mechanisms:
1. Attempts to interrupt type 1 worry
2. Suppress/remove thought triggering worrying from consciousness (rarely effective)
3. Lack of attempts to interrupt type 1 worry reduces opportunities to discover worrying is
subject to coluntary control.
People engage more in trying to remove the content of type 1 worry triggers from awareness than
interrupting the worry process.
Conclusions:
- GAD patients have higher negative beliefs about uncontrollability and danger than other
people
- No difference in endorsement of positive metacognitive beliefs between GAD and other
people
- GAD patients report higher type 2 worries than other people.
- Differences in negative metacognitions are independent of Type 1 worry in the case of
negative beliefs concerning uncontrollability and danger.
Key symptom of GAD Worry defined as ‘apprehensive expectation’, repetitive thinking about
potential future threats, imagined catastrophes, uncertainties and risks, or thoughts, images which
are negatively affect and relatively uncontrollable.
, Source: Wells and Carter (2001)
Anxious people are highly alert/ aroused and in a state of ‘overpreparedness’ and hyperarousal
seems to be chronic.
Research: Heartrate for agoraphobia patients was way higher at each walk than of controls.
However, heartrate decreased/habituated in both groups over the 7 walks. Difference was the
increase in heartrate in the final walk in agoraphobia patients final exam effect.
Data shows no difference between the 2 groups in heartrate during frightening (for patients) walk,
relative to the heartrate on baseline measurements days.
- Patients are chronically overaroused and have a chronically high and labile heartrate
compared to controls.
Harmonic driving is higher in anxious patients than in non-anxious controls or depressed patients
(more beta activity and less alpha activity).
- Habituations of GSR (galvanic skin response) was much slower in patients than controls.
Normal controls and specific phobia patients both habituated quickly and had fewer spontaneous
fluctions (not the same overarousal). Social and agoraphobia with depression were chronically
overprepared.
GAD patients increased heartrate and less heartrate variability. Worrying is directly associated
with lowered parasympathetic control of cardiovascular functioning automatic inflexibility in
GAD.
Cognitive behavioural therapy→showed significant increases in heart rate variability and
parasympathetic tone.
Borkovec autonomic inflexibility in anxious patients is related to the fact feared stimuli are not
produced by external environmental stressors, but are (chronically present) internally generated
thoughts about potential future threats.
Furthermore, autonomic inflexibility seems to be a characteristic of anxiety disorders in general,
rather than a psychophysiological feature associated with just one disorder (for example it has been
noted in patients with panic disorder and OCD as well as GAD).
Source: Barlow (2002).
GOAL 2: WHAT ARE THE SYMPTOMS OF SOCIAL ANXIETY DISORDER?
Social Anxiety Disorder (social phobia):
A. Fear or anxiety about 1 or more social situations
a. Fear of acting a way/showing anxiety and being negatively evaluated
b. Social situations almost always provoke fear/anxiety
c. Social situations are avoided or endured within tense fear/anxiety
d. Fear/anxiety is out of proportion to actual threat
e. Persistent (>6 months)
f. Clinically significant distress/impairment
g. Not because of physiological effects or substance
h. Not because of other mental disorder
