What are the main features of pathological worrying and how does worrying contribute to generalised anxiety disorder?
Social and Personality Psychology
No. Words 1485
TITLE: What are the main features of pathological worrying and how does worrying contribute to generalised anxiety disorder?
Worry is a feature of most people's lives at some point. Everyone worries every now and then. When people's worries are uncontrollable, excessive and chronically present it interrupts with people's daily lives and people experience loss of enjoyment of living, life can become intolerable and may result in a condition known as generalised anxiety disorder (GAD). GAD is chronic worry about multiple life circumstances (Edelmann, 1992). O'Neill (1986, cited in Eysenck and Mathews, 1991) states that both anxiety and worry are associated with identical behavioural existence, worry is the cognitive component of anxiety, therefore worry not only leads to GAD but is part of GAD and helps to maintain GAD (Borkovec, Ray and Stober, 1988). Investigation into worry and it's connections with anxiety did not really start until the early 1980's. This essay is going to look at what pathological worry is, what GAD is and its symptoms, why people worry and how does worrying contribute to GAD.
Borkovec et al 1983 (cited in Davey, 1994) defined pathological worry as "a chain of thoughts and images, negatively affect-laden and relatively uncontrollable; it represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes." They found worry is highly related to feelings of fear and anxiety. Patients characterised what they felt when they worried; anxiety, tension and apprehension were rated most highly. The chronic worrier constantly engages in negative thinking, in the lab and in daydreaming (Pruzinsky and Borkovec, 1990, cited in Davey, 1994). Borkovec et al. (1991, cited in Brown, 1991) found that the predominant feature distinguishing pathological worrying and non-pathological worrying is the perception of uncontrollability, this feature of worry is a essential component of GAD. Meyer et al (1990, cited in Tallis, 1991) concluded that worry is characterised by self-evaluation, self-examination, avoiding control over events that affect oneself, high demands on one's own performance, unhurried speech and often feeling rushed for time. Leibert and Morris (1967, cited in Tallis, 1991) believe that worry is a cognitive concern about the consequences of failure and emotionality as perceived psychological change. Pathological worry is associated with worry about future events, it can cause a number of physiological symptoms such as increased body temperature (Ruma and Maser, 1985).
The DSM- IV criteria for GAD are as follows: excessive anxiety and worry for at least 6 months; difficulty in controlling the worry; the anxiety and worry are associated with 3 or more of the following symptoms (1) restlessness (2) easily fatigued (3) difficulty concentrating (4) irritability (5) muscle tension (6) sleep disturbance; the anxiety and worry are not part of another anxiety disorder; the anxiety or worry cause considerable distress and affect normal living; and the disturbance is not a result of a drug (Seligman, 2001). The hallmark of GAD is chronic, uncontrollable, excessive, unrealistic worry about ...
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The DSM- IV criteria for GAD are as follows: excessive anxiety and worry for at least 6 months; difficulty in controlling the worry; the anxiety and worry are associated with 3 or more of the following symptoms (1) restlessness (2) easily fatigued (3) difficulty concentrating (4) irritability (5) muscle tension (6) sleep disturbance; the anxiety and worry are not part of another anxiety disorder; the anxiety or worry cause considerable distress and affect normal living; and the disturbance is not a result of a drug (Seligman, 2001). The hallmark of GAD is chronic, uncontrollable, excessive, unrealistic worry about all sorts of things, in particular about violence, jobs or healthcare. GAD occurs in about 5% of the population, it is the most common anxiety disorder (Davidson and Neale (1998). GAD has physiological effects such as: increased muscle tension during rest and in response to challenge (Davey, 1994), and increases in EEG beta activity in the frontal lobes, especially in the left hemisphere indicating worry. Research had found that uncontrollability and unpredictability can increase worry of an event in GAD patients (Seligman, 2001). People with GAD are pre-occupied with thoughts (worries) about their personal capabilities and are often concerned about being evaluated by others (Tuma and Maser, 1985). Brown et al. (1991) found that GAD patients scored higher on the Penn State Worry Questionnaire than all other anxiety groups, highlighting that worry is the key symptom of GAD. There are many symptoms of GAD and different individuals are likely to suffer slightly differently, some of the most common symptoms are: sweaty palms, increased muscular tension, tension headaches, butterflies in the stomach, nausea, stomach cramps, difficulty in sleeping, palpitations, shortness of breath, breaking into sweats, trembling and increased heart rate (Last and Hersen, 1988).
Research has shown that there are a number of reasons why people worry. Borkovec and Roemer (1995, cited in Borkovec, 1998) found the highest rated reasons why both GAD patients and nonanxious people worry are that it helps them to think of ways to avoid negative future events, and it prepares them for the worst if they cannot avoid it. Therefore worrying may function as a cognitive avoidance response to threatening information. However in GAD patients often the threat only exists in their minds, and because the negative event never occurs they may think that it didn't occur because they worried about it, therefore reinforcing worrying. GAD subjects also believe that worry is an effective problem-solving method. GAD clients at the Penn State Programme were asked what function their worrying had, the following five reasons were most commonly given: (1) superstitious avoidance of catastrophe (2) actual avoidance of catastrophe (3) avoidance of deeper emotional topics (4) coping preparation (5) motivating device (Davey 1994). Roemer et al. (1991, cited in Davey 1994) found that GAD patients believed that their worrying distracts them from more emotional topics. Short periods of worry can lead to increases in negative thought intrusions, whereas lengthy exposures can produce an extinction-like effect. As in GAD patients brief periods of worry are more likely to occur in life, they become more frequent and negative (Stone and Borkovec, 1975, cited in Tuma and Maser, 1985). Worry is also dominated by negative thoughts rather than images (Borkovec and Inz, 1990, cited in Edlemann, 1992). Barlow (1988, cited in Edlemann, 1992) provided a model which involves a complex interaction of biological, psychological and social events. It focuses on biological vulnerability which is activated by negative life events. The events are perceived as unpredictable and uncontrollable, therefore attention is focused on the worry or concern and a subsequent spiral of worry.
The Penn State Programme (Davey, 1994) suggested that individual differences in threat perception explains the emergence of chronic worry. They found two key reasons why people with GAD feel as though they are not able to copy with what lies ahead of them. The first reason is a history of past traumatic events, and the other is insecurity in early childhood. If someone has experienced a traumatic event it is understandable why they may be fearful about the future. GAD clients report they have had more frequent traumas in their past than nonanxious people, however they worry less about illness/death/injury than any other topic category (Roemer, 1997, cited in Borkovec, 1998). This provides evidence that a function of worrying may be to avoid thinking about the really troublesome negative thought. It is also understandable if someone had insecure attachments as a child interacting with the world is a threatening prospect because of the absence of a safe place to go home to. Cognitive avoidance appears to work here as well as GAD patients frequently lack childhood memory, but report feelings of being rejected as children by the primary care-giver (Davey, 1994).
Beck et al (1985, cited in Edelmann, 1992) suggest that anxiety is maintained by elaboration, storage, selective encoding and retrieval of information concerned with personal danger. However these findings do not mean that the biases have a causal role in GAD, they may be secondary consequences. Worry seems to characterise GAD and play a key role in maintaining anxiety. Focusing on worrying thoughts can help avoid images and thoughts of the feared situation and so effective emotional processing is blocked and general anxiety maintained (Mathews, 1990, cited in Edlemann, 1992). Borkovec (1998) found that the occurrence of worry before or after threatening events decreased the emotional processing of those events and can lead to an increase in the anxious meanings surrounding those events. Catastrophising and worrying thoughts can strengthen fear structure by close association, which is turn can contribute to anxiety maintenance. Worry may produce anxiety about a person's inability to cope with anxiety-generating situations, this fear or fear phenomenon is particularly noticeable in GAD patients (Tuma and Maser, 1985).
In conclusion, everyone worries about some things at some times, but when someone's worry is excessive, uncontrollable and they constantly engage in negative thinking, the worry is pathological. Worry is the key cognitive component of anxiety, GAD is characterised by chronic, uncontrollable, excessive, unrealistic worry about a multitude of events. People worry because it helps to avoid thinking of negative future events and worrying acts as a negative reinforcer. GAD patients think worrying is a successful method of problem-solving, this is reinforced because most of the things GAD patients worry about are very unlikely to actually ever occur and so never do. Individual differences explain why some people's worry becomes pathological, and other people's doesn't. A history of trauma and insecure attachments in early childhood are common features of GAD patients. Chronic worry leads to GAD and plays a key role in maintaining anxiety.
Bibliography
Borkovec, T. D., William, J. R. and Stober, J. (1998) Worry: A Cognitive Phenomenon Intimately Linked to Affective, Physiological, and Interpersonal Behavioural Processes. Cognitive Therapy and Research, 22, 6, pp.561-576.
Brown T. A., Antony, M. M. and Barlow, D. H. (1991) Psychometric properties of the Penn State Worry Questionnaire in a Clinical Anxiety Disorders sample. Behaviour, Research and Therapy, 30, 1, pp. 33-37.
Davey, G. C. L. and Tallis, F. (1994) Worrying: Perspectives on Theory, Assessment and Treatment. Canada: Wiley.
Davison, G. C. and Neale, J. M. (1998) Abnormal Psychology. New York: Wiley and Sons, Inc.
Edelmann, R. J. (1992) Anxiety: Theory, Research and Intervention in Clinical and Health Psychology. New York: Wiley.
Last, C. G. and Hersen, M. (1988) Handbook of Anxiety Disorders. UK: Pergamon Press.
Seligman, M. E. P., Walker, E. F. and Rosenhan, D. L. (2001) Abnormal Psychology. New York: W. W. Norton and Company, Inc.
Tallis, F. Eysenck, M. W. and Mathews, A. (1991) Worry: a critical analysis of some theoretical approaches. Anxiety Research, 4, pp. 97-108.
Tuma, A. H. and Maser, J. D. (1985) Anxiety and the Anxiety Disorders. New Jersey: Lawrence Erlbaum Associates, Inc.
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