General Anxiety Disorder: Effective Treatments - Essay Example

?RUNNING HEAD: GENERAL ANXIETY DISORDER General Anxiety Disorder: Effective Treatments BY YOU YOUR SCHOOL INFO HERE HERE General Anxiety Disorder: Effective Treatments Introduction There are nearly seven million adults in the United States alone that currently experience symptoms of generalized anxiety disorder (GAD). GAD involves excessive worry over past and future scenarios with a variety of clinical and cognitive-based symptoms that radically affect the individual’s ability to cope with life effectively or manage themselves according to proper social norms in the social environment. Generalized anxiety disorder requires interventions from therapists in order to manage these symptoms and come to grips with the root of what is causing feelings of anxiousness and excessive worry. The most effective treatments for generalized anxiety disorder are the cognitive behavioral therapy approach, humanistic psychology, and psychodynamic therapies. Based on reputable research information associated with these three therapies, this paper intends to prove that GAD can be effectively managed or even cured using person-centered psychological therapies. What is GAD? Generalized anxiety disorder is defined as “an anxiety disorder characterized by prolonged vague, but intense fears not attached to any particular object or circumstance” (Morris & Maisto, 2005, p.499). GAD is usually accompanied by, but not limited to, highly neurotic tendencies, muscle tension, excessive pounding heart rhythms, apprehensiveness about future events, and a variety of sleeping difficulties (Morris & Maisto). It is clinically diagnosed when the individual suffering anxiety symptoms has experienced these for at least six months and maintains at least three of the aforementioned symptoms (Mackenzie, Reynolds, Chou, Pagura & Sareen, 2011). People who suffer with generalized anxiety disorder typically have a problem functioning properly socially due to their constant concerns over past mistakes and maladjusted views about tomorrow. GAD can also be caused by inherent beliefs regarding one’s role in the external environment, under the principle of the locus of control. Locus of control is the level to which an individual believes their life is controlled by their own motivations or whether the external environment is directly responsible for influencing their personal destiny (Treven & Potocan, 2005). People with an internalized locus of control believe they have significant impact on their own direction and can control outcomes through self-motivation. Those with an externalized locus of control believe that outside forces are dictating whether or not they succeed in life or socially and it is usually this type of individual that has the most risk factors for generalized anxiety disorder. It is necessary to get to the root of what is driving maladapted thoughts regarding perceptions of lifestyle control in order to gain mastery over symptoms of GAD, accomplished largely through three types of therapeutic options. Cognitive Behavioral Therapy The cognitive psychological school of thought typically believes that a functional analysis is necessary to ensure to help the individual identify with their distorted thoughts, emotions, and perceptions to ultimately new methods to gain control over the anxiety symptoms. Albert Ellis, a renowned psychologist, believed that most people are left unhappy due to their own “faulty and irrational belief systems” which directly influences how they interpret situations and events (Magill, 1998, p.27). It is believed to be a product of classical conditioning, the family structure and its impact on youth and adult development, or other byproducts of operant conditioning. In order to get the root of what is driving anxiety symptoms and why the patient expresses such constant worry, the cognitive behavioral approach is known to have quality outcomes in improving GAD symptoms over the short- and long-term. One of the main problems associated with generalized anxiety disorder is that the patient often avoids uncomfortable feelings and therefore does not cope effectively like other more well-adjusted members of society. In cognitive behavioral therapy (CBT), the therapist takes the role of both mentor and counselor to help the patient identify with their distorted reasoning and perceptions and remove all factors of avoidance related to difficult emotions. Common elements of cognitive behavioral therapy include identifying what strategies are currently being used that are unhelpful in coping and assisting in finding more useful ways to manage stress. The goal of assisting a person with GAD is to help them relax, thus relaxation techniques and stress reduction exercises are common to assist in normalizing irrational responses (Oliver & Lewis, 2009). In some cases, people with generalized anxiety disorder have a difficult time communicating properly and lack the aggressive capabilities to manage themselves in stressful scenarios. Therefore, oftentimes assertiveness training is required as a means to reduce the more dramatic symptoms of irritability, agitation, or constant worry about situations that are usually minor in nature. Therefore CBT can be referred to as a type of therapy that assists in helping to function daily in life and also help control the physical symptoms that plague one with GAD. Because the patient usually avoids dealing with complex emotions, one element of cognitive therapy is to teach the patient how to simply allow anxiety to occur rather than trying to constantly fight against it or avoid it. This is done by making comparisons, such as metaphors, to help the patient gain a new understanding of why they avoid the emotions to begin with. For example, one study identified success in treating GAD by comparing the struggle with anxiety to a pool of quicksand: the more the patient struggles the faster they sink (Codd, Twohig, Crosby & Enno, 2011). Metaphors such as this help the patient to see the futility of struggling against common anxiety and simply finding new methodologies to ensure a better coping system. Socially, people with generalized anxiety disorder will, in social scenarios, try to divert their peers away from discussing core concerns and worries as a means to avoid situational discussions that lead to emotional pain (Portman, Starcevic & Beck, 2011). A therapist using cognitive behavioral therapy would, in this case, take the role as an empathetic leader and thus act as a lifestyle coach. “The more the client perceives the therapist as real and genuine, as having unconditional love for him, the more they will move away from static, fixed, and impersonal type of function (Rogers, 2002, p.55). The goal is to help the client reach a new level of maturity through relationship development based on openness, mentoring and overall trust in the patient-therapist relationship. Cognitive behavioral therapists realize that when treating GAD symptoms, the patient will often feel that their therapist lacks proper empathy. Statements such as you simply do not understand how terrible I feel are common with those suffering GAD symptoms (Leahy, 2008). What the patient is attempting to do, once again, is avoid taking personal responsibility for their anxiety worries and distorted concerns and therefore transfer their aggression to the therapist. A therapist using the CBT approach understands this, validates these feelings, develops a sense of trust and compassion, and then over time steers the patient toward understanding that they are not alone and that feelings of anxiety are commonplace to most adult individuals. In a sense, the therapist conditions the patient to understand the complexity of their avoidance and then, using role-playing or other experiential exercises, helps the patient gain ground on mastering their negative emotional responses and assume responsibility for the actions associated with avoidance and transference. CBT is most effective for GAD when there is a measurement system in place along with the relationship-based role of the therapist. A life events inventory or a ways of coping questionnaire are two common areas to help the patient identify their unique strengths or weaknesses. During the sessions, which typically last approximately 12 weeks in order to reduce or cure the symptoms of generalized anxiety disorder, these assessments can be used as tools to show the patient hard data that they have changed their attitudes and distortions, thus building a sense of confidence about progressing in the future without the therapist there to guide behaviors and concepts. There is not one, singular approach to CBT that will work effectively, therefore the therapist must determine which elements are most effective after an in-depth functional and skills analysis of the patient. It is often the cognitive processes that guide irrational thinking, feeling or behaving, therefore the aim is simply to gain ground in providing a tool for rational thinking and avoid worry about situations that are fabricated or out of the patient’s personal control. Humanistic Psychological Approaches Outside of the CBT approach, there is a similar domain of psychology referred to as humanistic therapy that also focuses on changing behaviors, but puts more emphasis on the relationship between therapist and patient. It is founded largely on the principles of Abraham Maslow, a 20th Century psychologist, who established the Hierarchy of Needs that categorizes the five fundamental needs of every human. Most people are driven to behave and feel based on their own motivations and will respond according to what brings them the most satisfaction. Maslow proposed that people move through a tiered system of needs, unable to progress to the next tier until the previous need has been fulfilled effectively (Morris & Maisto). Some of the most common needs on the hierarchy are a need for affiliation, security and self-confidence in order to become fully actualized, this being the reaching of one’s total capacities to be fully functional in society and content with their own identity and lifestyle choices (Clay, 2002). A therapist using strategies in humanistic psychology to cure generalized anxiety disorder have a much more bonded relationship with the patient, approaching the individual with the assumption that everything about them is good and worthwhile. In this role, the therapist acts much like a trusted parent or best friend associate in order to get the patient to open up about their feelings and experiences both past and present. A person who is experiencing GAD symptoms usually develops their worry and anxieties as a matter of being limited in options when facing perceived threats to their health or emotional security. Much like Maslow’s proposed concept that people need to feel a sense of security in order to feel a quality sense of belonging, a person with GAD often feels this security is being disrupted for one reason or another, thus they never gain self-confidence or a sense of affiliation in the social environment. When the tier of security is perceived to be threatened, the individual is stuck in a stagnant pace of lifestyle and thinking. At the same time, the GAD patient perceives threats that exist mostly in the future, therefore the general flight or fight response is totally unavailable in the here and now and the only way to cope with the threat (either real or imaginary) is through worry (Fisher & Wells, 2011). The individual in the humanistic field of therapy recognizes this factor, and therefore takes the aforementioned role of mentor and friend and works strongly at ensuring that issues of current security, both emotional and physical, are addressed in abundance so that they gain a sense of empowerment and belonging through the actions and language of the counselor. “Worry is a chain of thoughts and images, negatively affect-laden and relatively uncontrollable, where worry is related closely to the fear process” (Turk & Mennin, 2011, p.73). Therefore, the humanistic counselor helps to create a new set of images that are related to peace, relaxation, and where security is of the utmost priority in terms of establishing a sense of safety with the client. This is important for the individual facing symptoms of generalized anxiety disorder as a variety of their concerns are over financial worries, family worries, or their own social inadequacies. Since much of this type of therapy is built on Maslow’s belief that security is necessary to achieve self-confidence and self-esteem, the therapist uses dialogue similar in nature to that of children needing parental care, love and reinforcement. Since the process of worry, itself, is often uncontrollable, the therapist must focus on the patient himself related to their emotional capabilities and level of maturity to improve their sense of protection, safety, and refuge through the counseling relationship. This type of therapy might also involve relaxation therapies as well as stress reduction techniques in a calm and non-threatening environment. The goal is to get the patient to desire being with the therapist and thus trust in the ability to show candor about their total thinking and feeling processes. Helping the patient to gain mastery over their physical symptoms, such as through breathing exercises, is another method to ensure the person suffering from generalized anxiety disorder does not experience heart palpitations during times of worry and debilitating muscle fatigue common with this problem. Psychodynamic Therapies Completely different from CBT and humanistic psychology is a more intense, analytical method of helping patients with GAD known as psychodynamic therapy. Many of the concepts involved are based on traditional Freudian beliefs in the unconscious as a major contributor to what is causing anxiety and neurosis with the patient. In the psychotherapeutic approach, the relief of emotional stress and learning to halt avoidant behaviors starts with analysis of the patient’s past and identify what factors in lifestyle might have led to these worries and concerns that plague the patient. It is defined as the belief that GAD is developed directly from early youth experiences and the role of the unconscious in burying negative or unpleasant thoughts from these periods as a means to cope as an adult (Sundberg, 2001). This type of therapy focuses on reducing defense mechanisms that are common to those with generalized anxiety disorder and assisting in working through today’s crises by understanding yesterday’s frustrations in equal measure. There is much emphasis on the interpersonal dynamics of the patient’s lifestyle in psychodynamic therapy where the unconscious conflicts occurring in the mind of the patient relate directly to their current state of development. Common interventions include typical Freudian methodology such as relaxation and free association, usually accompanied by a more firm approach to dialogue that is much more direct and clinical rather than humanistic in design. The goal is to help the GAD patient understand their intrapsychic problems and avoid transference or the constant use of defense mechanisms to avoid unpleasant thoughts and feelings. Psychodynamic therapists focus on aspects such as regression, a reversion to immature behavior patterns (Weiten & Lloyd) or projection, where the patient attributes their own dysfunctional thinking to another. These are common aspects associated with a person who has many symptoms of generalized anxiety disorder. The role of the therapist is to help the patient understand that they are using these negative defense mechanisms so as to cease the behavior. In situations such as regression as a means to cope with difficult thoughts, anxiety is the byproduct of unhealthy coping when they do not receive the level of attention or receive the self-esteem boost they were hoping for through regressive strategies. The therapist must avoid indulgence in these behaviors when they have been identified and help the patient develop a more structured and appropriate method of dealing with social scenarios that are uncomfortable. Psychodynamic approaches to helping those with anxiety disorder can also include identifying rules for validation that the patient must abide by, through highlighting their idiosyncrasies or utterly irrational behaviors much like an authoritative parent. Even though not all people suffering with GAD maintain these extreme behavioral patterns leading to worry and concern, the therapist must create a structured program of treatment where patient self-deception is not tolerated. At the same time, exploring historical situations that might have led to the ongoing symptoms of anxiety give the patient the ability to find closure and acceptance about difficult past experiences so they can move forward as healthier adults. The goal is to get the patient to think more rationally and avoid maladaptive behaviors by gaining insight into their emotional distresses both past and present (Hoyer, Van Der Heiden & Portman, 2011). Conclusion All of the three different treatment options have their similarities and distinct differences, however each have been found to be effective in curing or lessening the burdens associated with generalized anxiety disorder in a variety of patients. Cognitive-based therapies deal with thought processes in a way that provides a greater sense of self-understanding using both relationship as a tool for success and to help the patient gain a better internalized locus of control. More effective coping strategies are the primary goal of this treatment as identified through the literature. Humanistic therapy involves the relationship aspect and aspects of compassion, love, friendship, and safety to ensure the patient is able to develop a wholly healthy sense of self. By reinforcing issues related to self-esteem and self-confidence, blending relaxation therapy, therapists find success in assisting the patient become more motivated to achieve their greatest accomplishments and be more effective as self-actualized members of society. By giving the patient opportunities to express their own aggressiveness, when appropriate, it can avoid the anxieties associated with difficult or uncomfortable social scenarios. It seems to be an effective treatment choice at ensuring a more relaxed patient posture and help them gain mastery over their many complicated physical symptoms. The psychodynamic approach was identified as being more authoritative and also more in-depth than the other treatment options with much more emphasis on the past as a catalyst for today’s anxiety symptoms. Bringing the conscious mind to the conscious so that the patient can recall what elements of the past have assisted in developing their current GAD symptoms is a primary part of this intervention. Taking less of a role as a friend and mentor and more of that of an rigid or strict parent to avoid indulgence in negative defense mechanisms, the patient seems to learn elements of self-obedience and also to control their negative impulses related to fruitless worry and concerns. Whatever strategy is chosen depends on the patient and their unique symptoms. Whether the therapist desires to be closer to the patient or maintain a more controlling distance depends on the extent of the anxiety symptoms. However, all three approaches have their merits and can be considered quality options for improving GAD symptoms in a variety of demographics across the country. References Codd, R., Twohig, M., Crosby, J. & Enno, A. (2011). 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