GAD (Generalized anxiety disorder) is perhaps the most misunderstood clinical condition. It becomes dangerous when used loosely by laymen and professionals without adequate clinical knowledge and training. My purpose of writing this blog is not to write ''about'' GAD but ''for'' it.
Last year, a colleague from the department of Egyptology approached me and said:
''I have cigarettes. They kick up the system and now I feel I got GAD. You know, I am crazy.''
I felt like clutching my head. I groaned ''Oh God! Not one more, please!!''
First of all, this person was a 100% sure he had GAD.
Secondly, he thought he was an expert and knew what moderated his so-labelled GAD because according to him, feeling anxious about everything defined GAD. Well, GAD isn't that simple.
I asked him, ''Do you know what GAD is?''
He fumbled. He knew he'd been caught on the wrong side but he was quick to reply, ''I think it's just feeling anxious about everything.''
''And what is that everything?'', questioned I.
''I can't clinically define it but this is what I feel''
''It seems you aren't sure what GAD is, are you?''
''No''
''And yet you, so confidently diagnosed yourself''
Most of us think we know ourselves the best, so we can give labels and having a psychological label sounds like a cool new thing on the block. You may know yourself the best, but you don't know the disorder itself. So think a hundred times before self-diagnosing.
Coming back to GAD, I won't defy everything my Egyptologist friend had said.
GAD does comprise of anxiety, but anxiety's second level, which is called meta-worry is the main driver for GAD. It's not the worry. It's worry about worry. Adrian Wells speaks of these cognitive levels in depth.
Borkovec and Newman (1992) have given another explanation stating that worrying is an attempt to avoid more acute distress. Confrontation with real life situations can be a real ''pain in the arse'' and worrying about them gives a sense of ''solving the problem in head'' (though they are never really solved). But you get the idea how it keeps going.
The third explanation is given by Quebec who says GAD develops with the habit of ''intolerance of uncertainty''. It is not good to remain uncertain.
Let me speak about my own self to elaborate Quebec's weird but true explanation.
Autumn 2009.
I was called in to see our neuropsychology professor, Dr. Tree.
I had read a lot of his work in journals and in books. I respected him and I still do.
However, I did not know why he had called me in his office. I couldn't stand that uncertainty. I was supposed to see him on Monday and the entire Sunday night was spent tossing in bed. Before some light sleep came over to me, I thought I must have failed my Neuropsychology assignment or must have done a project badly. Failing was bad, but was still better than uncertainty.
The next day I enter Dr. Tree's cabin with the conclusion that I must have failed. All I get to know was I had scored the second highest in the entire masters' batch in Neuropsychology Module.
So you see how important it is to be certain all the time?????!!!
That's how brains work!
And mind it, I wasn't diagnosed with GAD because again, we must bear in mind that clinical diagnosis does not depend on 1-2 such events.
GAD presents clinically in a million different ways, but in your case histories, it is very important to understand what events in their lives have precipitated their GAD. There may be many events, but some are crucial. Plus, there is one major philosophy behind GAD and it is:
''Over-estimation of the situation and under-estimation of their own coping resources''
Apart from that, ''Cognitive distortions'' or ''UTH'' (Thinking habits) as described by Burns (2000) must be outlined.With GAD patients, they know they are thinking shit and they don't want to hear it from their doctor.
As a psychotherapist, never focus on telling them what's right and what's wrong. Try using Beck's Anxiety Inventory, HADS or GHQ (in general) and GAD-7, which is a specific GAD inventory to know the crucial potholes in their clinical condition and how it impacts their health.
Never underestimate the ''topics'' about which your GAD clients worry or say, seek internal safety. They might worry about a possible storm and their property getting destroyed, but that cannot be stamped as ''illogical''. If you try to explain the ''truth'' or ''logic'' of the thinking, you'll only involve in an argument. They are not wrong because an unlikely storm is absolutely possible......but why do they worry about it and we don't?
Statistics are alarming.....I don't buy into them, nor would I advise anyone to remember and buy into statistics. They are not perfect and so are researchers (they are more than imperfect)
There is a little more for those who are interested:
There is one more aspect which is good only to rely on when reading; it is Neurobiology of GAD (or any other condition for that matter)
What I present here may not necessarily be the truth, so it is important to be objective.
Just as any clinical condition is bound to cause alterations in chemical, hormonal and neuronal features of the body/ brain, there's one sure universal fact; the brain is affected. You cannot have just a few areas of brain getting affected in isolation.
I would bring into picture Amygdala (the old brain emotional centre), peri-amygdala regions (for the same emotions) as well as Pre-frontal cortex (for cognitive processing).
I might be saying this because I am CBT therapy oriented where cognitions and emotional reaction is the key behind understanding any disorder.
Biologists and neuropsychology may rely more on Hippocampal regions to understand the impact of ''narrative events'' from case histories.
Most studies are based on activities shown in MRI and PET-scans, but even these and FMRI scans can only speak about the glucose activity going on in these regions at that point of time and since this is extremely fickle, it is hard to put a stamp of 100% objectivity here as well.
The answer to this and many other questions leads us to the topic of GAD treatment which is not the purpose of today's blog.
I have tried clarifying clinical GAD in a simple manner. I have tried my best to avoid technical terms and jargons and stick to examples from real life events. I just thought this wouldn't make the blog look like an academic lesson. Your feedback is very important to me.
Thank you very much.
Phoram Trivedi.
Last year, a colleague from the department of Egyptology approached me and said:
''I have cigarettes. They kick up the system and now I feel I got GAD. You know, I am crazy.''
I felt like clutching my head. I groaned ''Oh God! Not one more, please!!''
First of all, this person was a 100% sure he had GAD.
Secondly, he thought he was an expert and knew what moderated his so-labelled GAD because according to him, feeling anxious about everything defined GAD. Well, GAD isn't that simple.
I asked him, ''Do you know what GAD is?''
He fumbled. He knew he'd been caught on the wrong side but he was quick to reply, ''I think it's just feeling anxious about everything.''
''And what is that everything?'', questioned I.
''I can't clinically define it but this is what I feel''
''It seems you aren't sure what GAD is, are you?''
''No''
''And yet you, so confidently diagnosed yourself''
Most of us think we know ourselves the best, so we can give labels and having a psychological label sounds like a cool new thing on the block. You may know yourself the best, but you don't know the disorder itself. So think a hundred times before self-diagnosing.
Coming back to GAD, I won't defy everything my Egyptologist friend had said.
GAD does comprise of anxiety, but anxiety's second level, which is called meta-worry is the main driver for GAD. It's not the worry. It's worry about worry. Adrian Wells speaks of these cognitive levels in depth.
Borkovec and Newman (1992) have given another explanation stating that worrying is an attempt to avoid more acute distress. Confrontation with real life situations can be a real ''pain in the arse'' and worrying about them gives a sense of ''solving the problem in head'' (though they are never really solved). But you get the idea how it keeps going.
The third explanation is given by Quebec who says GAD develops with the habit of ''intolerance of uncertainty''. It is not good to remain uncertain.
Let me speak about my own self to elaborate Quebec's weird but true explanation.
Autumn 2009.
I was called in to see our neuropsychology professor, Dr. Tree.
I had read a lot of his work in journals and in books. I respected him and I still do.
However, I did not know why he had called me in his office. I couldn't stand that uncertainty. I was supposed to see him on Monday and the entire Sunday night was spent tossing in bed. Before some light sleep came over to me, I thought I must have failed my Neuropsychology assignment or must have done a project badly. Failing was bad, but was still better than uncertainty.
The next day I enter Dr. Tree's cabin with the conclusion that I must have failed. All I get to know was I had scored the second highest in the entire masters' batch in Neuropsychology Module.
So you see how important it is to be certain all the time?????!!!
That's how brains work!
And mind it, I wasn't diagnosed with GAD because again, we must bear in mind that clinical diagnosis does not depend on 1-2 such events.
GAD presents clinically in a million different ways, but in your case histories, it is very important to understand what events in their lives have precipitated their GAD. There may be many events, but some are crucial. Plus, there is one major philosophy behind GAD and it is:
''Over-estimation of the situation and under-estimation of their own coping resources''
Apart from that, ''Cognitive distortions'' or ''UTH'' (Thinking habits) as described by Burns (2000) must be outlined.With GAD patients, they know they are thinking shit and they don't want to hear it from their doctor.
As a psychotherapist, never focus on telling them what's right and what's wrong. Try using Beck's Anxiety Inventory, HADS or GHQ (in general) and GAD-7, which is a specific GAD inventory to know the crucial potholes in their clinical condition and how it impacts their health.
Never underestimate the ''topics'' about which your GAD clients worry or say, seek internal safety. They might worry about a possible storm and their property getting destroyed, but that cannot be stamped as ''illogical''. If you try to explain the ''truth'' or ''logic'' of the thinking, you'll only involve in an argument. They are not wrong because an unlikely storm is absolutely possible......but why do they worry about it and we don't?
Statistics are alarming.....I don't buy into them, nor would I advise anyone to remember and buy into statistics. They are not perfect and so are researchers (they are more than imperfect)
What I present here may not necessarily be the truth, so it is important to be objective.
Just as any clinical condition is bound to cause alterations in chemical, hormonal and neuronal features of the body/ brain, there's one sure universal fact; the brain is affected. You cannot have just a few areas of brain getting affected in isolation.
I would bring into picture Amygdala (the old brain emotional centre), peri-amygdala regions (for the same emotions) as well as Pre-frontal cortex (for cognitive processing).
I might be saying this because I am CBT therapy oriented where cognitions and emotional reaction is the key behind understanding any disorder.
Biologists and neuropsychology may rely more on Hippocampal regions to understand the impact of ''narrative events'' from case histories.
Most studies are based on activities shown in MRI and PET-scans, but even these and FMRI scans can only speak about the glucose activity going on in these regions at that point of time and since this is extremely fickle, it is hard to put a stamp of 100% objectivity here as well.
The answer to this and many other questions leads us to the topic of GAD treatment which is not the purpose of today's blog.
I have tried clarifying clinical GAD in a simple manner. I have tried my best to avoid technical terms and jargons and stick to examples from real life events. I just thought this wouldn't make the blog look like an academic lesson. Your feedback is very important to me.
Thank you very much.
Phoram Trivedi.
Simple and best quality of explaination, a huge round of applause for your work.
ReplyDeleteIt is been rightly said, 'incomplete knowledge is dangerous', this is what happens to general public. Most of the time this misconceptions arise when they happen to read articles in the paper such as- Are you extremely worried? you have anxiety.
Thanks sooo much janhavi.......! You are a stud!!!
Delete