Generalized Anxiety Disorder And Its Theoretical Models

One way or another, we are all familiar with the concept of anxiety. We know that it affects each person in a different way and that there are several disorders associated with it. One of them is  generalized anxiety disorder. For example, the DSM-5, Diagnostic and Statistical Manual of Mental Disorders, states that anxiety has different forms. One of these is generalized anxiety disorder or GAD.

This disorder is characterized by the presence of excessive, persistent anxiety and preoccupations that people have difficulty controlling. They relate to different events or activities and are associated with three or more physiological overactivation symptoms. On the other hand, in GAD, anxiety or preoccupation must be present most of the time for a minimum of 6 months.

The evolution of generalized anxiety disorder (GAD)

GAD was first introduced as a  single diagnosis in the Third Edition of the Diagnostic and Statistical Manual of Mental Disorders  (DSM-III). However, it began to be used more frequently as a residual diagnosis for individuals who did not meet diagnostic criteria for other anxiety disorders.

In the DSM-III-R publication, GAD was defined as a chronic and persuasive concern. A little later, in the DSM-IV-TR, GAD was characterized by  excessive uncontrolled preoccupation, related to various topics, which occurs most of the time for at least six months. The concern causes discomfort and / or functional deterioration and is associated with at least three of the following:

• Worry or feeling excited or nervous
• Fatigue that appears easily
• Difficulty concentrating, “empty” mind
• Irritability
• Muscle tension
• Sleeping troubles

Psychotropic drugs and cognitive behavioral therapy (CBT) appear to be effective in the treatment of GAD. For this disorder, drug therapy may be effective in reducing symptoms of anxiety. However, drugs do not appear to have a significant impact on concern, which is the defining characteristic of GAD.

Current theoretical models of generalized anxiety disorder

Concern Avoidance Model and TAG (MEP)

The Concern Avoidance Model and TAG are based on Mowrer’s (1974) two-phase fear theory . This model derives from Foa and Kozak’s emotional processing model.

The MEP asserts that  preoccupation is thought-based verbal linguistic activity that inhibits experienced mental images and associated somatic and emotional activation. This inhibition of the somatic and emotional experience avoids the emotional processing of fear that is theoretically necessary for successful habituation and extinction.

Uncertainty Intolerance Model (ITN)

According to the Uncertainty Intolerance (IBD) model,  individuals with GAD find situations of uncertainty or ambiguity “stressful and disturbing” and experience chronic preoccupation  with these situations.

These individuals believe that  the concern will serve them either to cope more effectively with the feared events or to prevent these events from happening. This concern, together with the accompanying feelings of anxiety,  leads to a negative orientation to the problem and cognitive avoidance, which feeds back the concern.

More concretely, individuals who feel a  negative orientation to the problem:

• Lack of confidence  in their ability to solve problems
• See problems as threats
• Get frustrated easily when faced with a problem
• Are pessimistic about the outcome of their efforts to solve the problem

These thoughts serve to  exacerbate their preoccupation and anxiety.

The metacognitive model (MMC)

The metacognitive model (MMC) of GAD postulates that  individuals with GAD experience two types of concern. The author Wells first identifies a  type 1 concern.  During this process, we see a preoccupation with non-cognitive events, such as  external situations or physical symptoms  (Wells, 2005). ).

For Wells, individuals with GAD begin to worry about their Type 1 concern. They fear that it will get out of hand or that it could be dangerous. This “preoccupation with concern”  (ie a meta-concern) is called, according to Wells,  the type 2 concern.

This type 2 preoccupation is associated with a set of ineffective strategies intended to avoid the preoccupation, through attempts to control behaviors, thoughts and / or emotions.

Emotion deregulation model

The Emotion Deregulation Model (DEM)  is based on the theory of emotion and the regulation of emotional states in general. This model consists of four central components:

• The first component claims that individuals who suffer from generalized anxiety disorder experience  emotional over-arousal  or emotions that are more intense than the majority of people. This concerns both positive and negative emotional states, but especially the negative ones.
• The second component refers to the  poor understanding of emotions on the part of individuals with GAD. This includes deficits in the description and labeling of emotions.
• The third component asserts that  individuals with GAD have more negative attitudes towards emotions than others.
• Furthermore, the fourth component focuses on the fact that these individuals exhibit  little or no adaptive regulation of emotion. They have coping strategies that cause them to experience emotional states that are even worse than those they were trying to regulate.

Generalized Anxiety Disorder (MBA) Acceptance Based Model

According to authors Roemer and Orsillo, the MBA involves  four components:

• Internal experiences
• A problematic relationship with internal experiences
• Experiential avoidance
• Behavioral restriction

Thus, the creators of this model suggest that “individuals with GAD have  negative reactions to their own internal experiences  and are motivated  to try to avoid these experiences,  which they do from a behavioral point of view and cognitive (through repeated participation in the preoccupation process) ”.

So we can say that  the five theoretical models share an important point. This focuses on the consequences of  avoiding internal experiences as a strategy of confrontation. In recent years, research has advanced considerably in the theorization of this disorder. However, more is needed to examine the predictive components of the five models.

Our thoughts

Generalized anxiety is a disease that affects our quality of life and can make us prisoners of ourselves. Let’s learn how to get out of it.