General Anxiety And Its Theoretical Models

Somehow we all know a little bit about the concept of anxiety. We know that it can affect a person in his own way and that there are a number of disorders associated with it. One of them is called general anxiety. The list of mental illnesses (DSM-5) defines anxiety in several ways, including generalized anxiety disorder (GAD).

This disorder is characterized by the occurrence of anxiety and an excessive persistent concern that it may be difficult to control. These concerns may be over different events or activities and are the result of three or more physiological symptoms of overactivation.

In addition, patients with generalized anxiety disorder suffer from anxiety or worry most days over a period of at least six months.

The development of generalized anxiety disorder (GAD)

The third edition of the list of mental illnesses (DSM-III, APA, 1980) first introduced generalized anxiety as a unique diagnosis. However, professionals used it as a diagnosis for the rest who could not meet the requirements of the other diagnoses for anxiety (1).

The list defined GAD as a chronic and compelling concern (2). Later in the next edition, DSM-IV-TR, it is characterized as an excessive, out of control concern in relation to various topics that pop up most days for a period of at least six months.

At the same time, the excessive worrying creates discomfort and / or functional decay. It also consists of at least three of the following aspects:

• Restlessness or feeling of arousal or nervousness.
• Fatigue.
• Difficulty concentrating.
• Irritation.
• Muscle tension.
• Difficulty sleeping.

Psychiatric medication and cognitive behavioral therapy (CBT) are used to treat GAD (3,4,5). Pharmacotherapy can be effective in reducing the symptoms of anxiety. However, medication does not appear to have a significant impact on the concerns that are the defining feature of generalized anxiety disorder (GAD) (3.)

Contemporary theoretical models of general anxiety disorders

The model for avoiding worries and general anxiety

The worry-avoidance model (6) is based on Mowrer’s two-factor theory of fear (1974.) Similarly, it also incorporates some of its concepts from Foa and Kozak’s emotional theory of change (7,8).

The model for avoiding worries states that verbal language, thought-based activity, arises as an attempt to prevent living mental perceptions and associated somatic and emotional activation.

Specifically, this obstacle will make impossible the emotional processes of fear, which are a theoretical necessity for successful addiction formation and removal of dreaded stimuli.

The model of intolerance of the uncertain

According to this model, people with general anxiety will perceive situations of uncertainty or ambiguity as “stressful and annoying.” As a result, they will experience chronic anxiety in response to these situations (10.)

These individuals believe that worrying will help them cope more effectively with the events they fear. Or they may think that it will prevent these events from happening (11,12.)

This worry, along with the feelings of anxiety that come with it, leads to a negative approach to the problem. Similarly, it also leads to cognitive avoidance, which reinforces the concerns.

People who experience a negative approach to the problem will specifically:

• Have a lack of faith in their ability to solve problems.
• Perceive the problems as threats.

• Gets easily frustrated when faced with a problem.
• Are pessimistic about the results of their efforts when it comes to solving a problem.

These thoughts will only aggravate their worries and anxiety (10).

The metacognitive model (MCM) for generalized anxiety disorder

The metacognitive model of generalized anxiety postulates that individuals with GAD experience two types of concerns. Wells, the originator of the model, defined Type 1 concerns. This is when a person worries about non-cognitive events, such as external situations or physical symptoms (Wells, 2005.)

According to Wells, individuals will begin to worry about Type 1 concerns. They are worried that their worries are uncontrollable or that they may be dangerous in themselves. So this “concern over concern” (eg meta-concern) is what Wells calls a Type 2 concern.

Wells linked these Type 2 concerns with a set of ineffective strategies aimed at avoiding concerns. In particular, these strategies should consist of attempts to control behavior, thoughts and / or emotions (10.)

The model of emotional dysregulation (EDM)

The model of emotional dysregulation (EDM) draws on the literature on emotion theories and mood regulation in general. This model consists of four key components (10):

• The first component states that individuals suffering from generalized anxiety disorder experience an emotional hyper-arousal. In other words, their emotions are more intense than most other people’s. This applies to both the positive and the negative emotions, but mostly the negative ones.

• The second component assumes that people with GAD have a poor understanding of emotions. For example, it can be about shortcomings in describing and establishing emotions. This also applies to the approach and use of important information where emotions are involved.
• The third component claims that people with generalized anxiety disorder have more negative attitudes towards some emotions than other people.
• Finally, the fourth component specifies that these individuals with GAD have little or no regulation of the adaptive emotions. Thus, they may also have some coping strategies that potentially leave them in an emotional state that is worse than the one they were originally trying to regulate.

Acceptance-based model for general anxiety (ABM)

According to authors Roemer and Orsillo, ABM contains four components:

• Internal experiences

• A problematic relationship with the internal experiences.
• Experimental avoidance.
• Behavioral restriction.

Therefore, the creators of this model suggest that people with generalized anxiety disorder have negative reactions to their own internal experiences and are motivated to try to avoid these experiences, which they do both behaviorally and cognitively (through repeated engagement in the worrying process.)

We can conclude that the five theoretical models share an important characteristic. They all focus in particular on the consequences of avoiding internal experiences as a survival strategy.

In recent years, research has revealed much in terms of getting theories made on this disorder. But there is a need for more thorough research on the predictable components of the five models.