A cognitive-behavioral approach to generalized anxiety disorder

Abstract: Generalized anxiety disorder (GAD) is a prevalent anxiety disorder with an estimated lifetime prevalence of about 5%. Relatively little research regarding psychopathology and treatment exists on this disorder. Worry is the dominating feature of GAD together with a set of characteristic somatic symptoms (motor tension, vigilance and scanning). The main purpose of the present thesis has been to focus on different important aspects of GAD which, at the present state of research lack information in regard to many of the other anxiety disorders; i.e. frequency and intensity of symptoms, cognitions and cognitive style, and efficacy of psychological treatment. A total of 44 patients that fulfilled the diagnostic criteria of GAD were subjects in the present thesis. The patients were investigated on numerous demographic and diagnostic features. It was found that the GAD-patients reported that they spent more than 50% of an average day worrying. Usually they worried over minor everyday matters. Themost frequently reported worry theme was family and children. Commonly reported symptoms were difficulties in concentrating, feeling keyed up, irritability, muscle tension, and restlessness. Furthermore, cognitions were studied using different methodological approaches, with panic disorder patients as a comparison group. When using a structured interview it was found that the GAD-patients' cognitive content fell in the category of mental catastrophes. When categorising self-observations of experienced anxiety the GAD-patients were found to have thoughts and worries about interpersonal confrontation, competence, acceptance, concern about others, and worry over minor matters. An attempt to clarify cognitive bias in anxiety disorder patients was made within a multicenter study. The results supported the hypothesis that panic disorder patients are particularly prone to misinterpret bodily sensations compared to other anxiety patients, (GAD, and social phobia) and nonpatients. Finally, the efficacy of a coping-technique (applied relaxation) and cognitive therapy was investigated ina randomized treatment study. The results showed that these two psychological treatment methods yielded fairly large improvements, which were maintained at a one-year follow-up. The results in this thesis support important parts of the cognitive-behavioral theory of GAD. Furthermore, the results may contribute to a better understanding of the debated diagnosis of GAD.