The Power of Worry: Generalized Anxiety Disorder John D. McKellar, PhD Clinical Psychologist Department of Veteran Affairs, Clinical Educator Stanford University

Generalized Anxiety Disorder Excessive worry –Uncontrollable –Multiple issues Physical symptoms –Muscle tension, insomnia, fatigue, tension Cognitive symptoms –Irritability, poor attention 6 months or more

Course and Prognosis Prognosis Chronic and (sometimes) debilitating illness 90% have co-morbid psych illness Significant functional impairment across cultures Most seek out general practitioner for somatic complaints Many resist diagnosis

Effective Treatments for GAD Medications -Benzodiazepines (Ativan) -SSRIs (Prozac, Zoloft) -Pregabalin (Lyrica) Disadvantages -Only tested for short term efficacy (6-8 weeks, long terms effects not known) -Problems of tolerance and addiction with benzodiazepines -Side effects

Effective Treatments for GAD Psychotherapy -Cognitive Behavioral Therapy -Mindfulness-Based Interventions

CBT for GAD Components 1.Education

Evolution of Anxiety Disorders Adaptive Maladaptive True Alarm No Threat Real Threat False Alarm Anxiety Anxiety Disorder  Excessive  Inappropriate  Impairs functioning

GAD Viewing Situation as Threatening Tension, Fatigue, Tingling sensations, etc. Worry

CBT for GAD Components 1.Education 2.Cognitive Interventions: De-Catastrophizing Worksheet

Anxiety Disorders De-catastrophizing worksheet for panic attack: What has happened in the past? How likely is this? So What? What if my boss is thinking of firing me? De-catastrophizing (Is this possible/likely? So what!!!) Catastrophizing Thoughts (What if…)

CBT for GAD Components 1.Education 2.Cognitive Interventions: De-Catastrophizing Worksheet 3.Relaxation Training 4.Exposure: Worry Time; Imaginal Exposure

Worry Time 1.“Schedule” a time to worry each day 2.Allows your worries to run, label as “good worry” or “bad worry” 3.Write down your thoughts and problem solve the “good” worries 4.When worries arise gently tell yourself “I will worry about that during Worry Time”

Imaginal Exposure 1.Choose a situation causing worry such as concern over being fired 2.Write out a description of the scenario 3.Either imagine the situation slowly in a repeated fashion or listen to a tape repeatedly of the described situation 4.Repeat until anxiety subsides

TIME Anxiety ESCAPE

Mindfulness for GAD 1.Practice Mindfulness training techniques that sustained attention on a single object (a word, breath, image, etc.) regardless of “worrying” behavior 2.After attaining some level of success in focusing attention (#1) then the effort moves to separate from thoughts (worry) and to experience the “threats” without judgement

Self-Help Resources 1.Mastery of Your Anxiety and Worry: Workbook (Treatments That Work) by Michelle G. Craske and David H. Barlow 2.The Mindful Way through Anxiety: Break Free from Chronic Worry and Reclaim Your Life by Susan M. Orsillo PhD, Lizabeth Roemer PhD and Zindel V. Segal PhD