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Generalized Anxiety Disorders: A Case Study

Introduction to Generalized Anxiety Disorders and Treatments in Adults This treatment paper offers to acquaint the reader with information regarding the significance, impact and treatments of generalized anxiety disorder (GAD) in adults. Among one of the most prevalent disorders in the United States, GAD has the propensity to severely hinder one’s everyday style of living and is listed within the Diagnostic and Statistical Manuel of Mental Disorders (American Psychiatric Association [APA], 2013), as code F41. 1 [300. 02].

Even though it is a fact that most people experience anxiety from time to time, those with GAD, as stated by the APA (2013) experience extreme and uncontrollable anxiety levels. Symptomology of GAD can be widely varied, but must meet the APA (2013) diagnostic criteria to be considered a disorder. Treatment options are many and for the best outcome for the client, should be tailored to fit the specific client. A well-researched treatment therapy that will predominately be discussed is, cognitive behavioral therapy (CBT) and two treatment techniques; countering method and mindfulness based stress reduction.

Symptomology of Generalized Behavior Disorder For those who are diagnosed with generalized anxiety disorder, many will have experienced physical symptoms, (American Psychiatric Association, 2013), such as shakiness, tense and twitchy muscles, an increase in heart rate, sweating, stomach upset, dizziness, nausea and shortness of breath. An article from the American Psychological Association (2016) states that those with GAD sometimes experience feelings of impending doom and as if being on the edge of some negative catastrophe.

Women are two times more often to exhibit GAD than men, according to the APA (2013), and all adults tend to excessively worry on a day-to-day basis, about their habitual routines surrounding responsibilities, lifestyle, job, health, income, family life and children. Aspects that distinguish GAD from other disorders in this class as listed in the APA (2013) are the absence of panic attacks, a substantial reduction in psychosocial functioning, all-encompassing worry, and distress that occurs often without justification.

Cognitive Behavioral Therapy In the treatment of GAD, one well established, first line treatment for adults, is cognitive behavioral therapy (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). Additionally, the benefit of treating anxiety with CBT, says Hofmann et al. , (2012), is that it has also been shown to assist with improvement in the areas of sleep inadequacies and in those with a proclivity towards anxiousness. CBT is as effective as relaxation therapy, as evidenced in the comparison done by Hofmann et al. , (2012).

While CBT is the standard for treating adults with GAD, some clients remain resistant to the process says Aviram, Westra, Constantino, & Antony (2016), in their article in the Journal of Consulting and Clinical Psychology. They identified the relationship of the counselor’s attitude of empathy, support of the client’s individuality and willingness to work together as a team as being paramount in decreasing and lowering instances of resistance by the client in the event of a disagreement.

Therefor, since the interaction between the client and therapist is important in achieving optimal outcome of CBT, Aviram et al. (2016) suggests it is crucial that the counselor receives effective training. Motivational Interviewing Approach to Cognitive Behavior Therapy From the beginning of CBT it is important to utilize a motivational interviewing (MI) approach with the client (Westra, Constantino, & Antony, 2016), to form a holistic image of the client’s main areas of anxiety and concerns. Additionally, it is useful to utilize the act of reflective listening so the client knows you are focusing on their needs and goals as well as putting them at ease within the session.

Studies are showing CBT is more effective when using the MI approach, reports Westra et al. , (2016). Through CBT the client will be taught to master techniques that will enable them to be in control of their internal dialogue resulting in more helpful responses to events (Erford, 2015). Moreover, Erfod states the ability to recognize, stop and replace the dialogue the client feels is faulty or detrimental, is the goal. Therefore, Erford suggests, after the establishment of a positive client/counselor relationship, the implementation of a countering method be utilized.

Hence, because people with GAD engage in negative self-talk, (Boyes, 2012), utilizing the countering method through a four-step process is the first CBT technique to be discussed. Countering Method of Cognitive Behavioral Therapy The countering method’s first step according to the book, 40 Techniques Every Counselor Should Know (Erford, 2015), is to talk about the details of the negative self-talk in which the client engages. Subsequently, the first step in this process is when the counselor asks the client open-ended questions about their personal, individual beliefs and values they feel are important.

The counselor will then ask the client to document for one week, on a note card suggests Erford, every time they engage in pessimistic self-talk and include the circumstances surrounding the self-talk. Accordingly, Erford says during the next session the client and counselor discuss in what ways the negative self-talk serves them? During the second step of CM technique, the counselor helps the client to take a close look at what they are saying to themselves and challenge those thoughts that are not in alignment with the client’s beliefs and goals (Erford, 2015).

Erford suggests many find negative self-talk has become automatic and a habit that is difficult for the client to release because they perceive the self-talk as a means to protect themselves. In an article by Ben Martin Psy. D. (2016), he suggests the counselor give the client questions he can ask himself in the event of negative self talk such as; Do I have evidence that backs up, for or against, what I am telling myself? Are my perceptions of this event true? Am I making judgments without all the facts? How is this self-talk making me feel?

Is there another more self-caring way I can talk to myself? Is there a different way I can see this event that is more positive? How would I rather see myself surrounding this situation? If I clench my fists and tense up my muscles does this make me feel good or something different? Once the client becomes cognizant of how engagement in self-talk activity influences their thinking, feeling, and behavior, they can start to counter this behavior pattern and replace it with more empowering self-thinking, says Martin (2016).

At this third step, the client may be asked to write their new and positive statements and questions down, says Erford. Naturally he says, the client should practice using the counter statements they have devised on a daily basis, until it becomes second nature or habitual. Additionally, he states this process should be practiced five times per day for at least a week or longer if need be. GAD is characterized by two fundamental symptom groups (Dugas, Francis, & Bouchard, 2009). The first group symptoms, according to Dugas et al. consists of cognitive issues of pervasive and unregulated worry and anxiety about a future crisis and present or past event.

They describe the second group of symptoms as those physical symptoms such as tachycardia, muscle tension, nervousness, mental confusion and disruption in sleep pattern, dizziness and edginess to mention a few. The National Institute of Mental Health (NIMH, 2016), affirms that stress reduction techniques can be of beneficial use conjunction with CBT not only for GAD but in other disorders which are commonly comorbid such as depressive disorders and substance use disorders.

Mindfulness and Mindfulness Based Stress Reduction Techniques It has been well documented, says (Sharma, Mao, & Sudhir, 2012), that mindfulness based stress reduction (MBSR) and participation in mindfulness activities is efficacious for those with anxiety disorders and depressive disorders, says the APA. Mindfulness originated in the East from Buddhist philosophies of meditation but has no relation to any particular religion (Mayorga, De Vries, & Ann Wardle, 2016). It is used for the intent to regulate the response to stressors such as anxiety, explain Mayorga et al.

It is imperative to educate the client, defining the essence and aspects of mindfulness such as; being present in the moment, in a non-judgmental manner and accepting the moment as it presents itself (Hoge et al. , 2013). Hoge et al. , suggests that mental health and stability is directly related to self-compassion and a benevolent attitude toward one’s self. Consequently, in the study conducted by Hoge et al. , they found a lower level of mindfulness and self-compassion in those with GAD as compared to those individuals without anxiety issues.

Before beginning teaching MBSR techniques, it would be helpful to acquire a baseline level of anxiety through a measurement tool such as the Beck Anxiety Scale (BAS). This can be used throughout therapy to evaluate the effectiveness of MBSR techniques (Hoge et al. ). The opposite of being in a state of mindfulness is being on autopilot suggests Jon Kabbat-Zinn (2005). He says when one is worrying about the future and ruminating about the past, one cannot be in the present.

Clients can practice the art of being in the moment through the use of sitting or lying meditation, guided imagery, body-scan technique, yogic meditation, progressive muscle relaxation, tai-chi, walking meditation, mindful eating and breathing exercises says Kabat-Zinn. All of these techniques can be done by the client on their own, in times of stress or calmness, anywhere, between sessions with their counselor and can change the way in which they perceive and respond to events and situations (Kabat-Zinn, 2005).

Mindfulness does not require sharing of emotions or personal particulars from the client, therefor, Erford (2015) states, a broad array of those with multicultural backgrounds will benefit. He also states many multicultural clients will appreciate that the focus of mindfulness does not rely on dredging up experiences from childhood or the past. For example, those with a Latino background do not normally feel comfortable divulging information regarding family matters. And, consequently, the Asian culture is not comfortable displaying emotions states Erford (2015) and may embrace mindfulness techniques.

Nevertheless, there are those with certain backgrounds that may envision mindfulness as a Buddhist religion and therefore be uncomfortable with this practice says Erford. In Jon Kabat-Zinn’s book, Full Catastrophe Living (2005) he discusses several techniques of mindfulness. However, this paper will focus on one technique described by Kabat-Zinn and Thich Nhat Hanh (2010); meditation. The counselor starts by explaining to the client that throughout meditation they will be conscious and in control at all times (Kabat-Zinn, 2005).

First one would sit upright in a chair without slouching as to allow for the ease of the breath to come in and flow out suggests Kabat-Zinn. Alternative to sitting, is positioning one’s self, supine on a mat or if one is ill on a bed and if needed a recliner. Take notice of the breath, states Thich Nhat Hanh (2010). He says to just notice that the breath goes in and it goes out. To be mindful, says Hanh, one must focus on something and for this meditation it is the breath and all aspects pertaining to breathing such as motion of the body in response to the breath.

To consciously be aware of breathing means one is alive and in the present moment he says. A point Kabat-Zinn makes is that most people will find their attention has moved away from the breath at times. He says be aware of this, accept this, do not judge this and bring the focus back to the breath. Next, as one begins to relax, become aware of being within the body along with the breath, says Hanh. He states the more aware one becomes of the body and breath, the more likely one will notice they are holding on to muscle tension somewhere.

On the out breath release the muscle tension and let the body melt into the floor or chair. This practice of meditation can be built upon and added into a walk. Some may only be able to do a brief meditation at first, says Kabat-Zinn. In addition, others find it helpful to practice a sitting meditation with sound such as ocean waves or whatever sounds are naturally present. Kabat-Zinn as well as Hanh, have audio guided meditations for those who enjoy being lead through a meditation practice. Psychology Today states mindfulness is a state of being and as such must be cultivated and practiced (Wegela, 2010).

The purpose of mindfulness meditation is aimed at getting one to recognize who one is right now, in the moment, suggests Wegela. Studies are showing that mindfulness therapy may help reduce anxiety and stress through the practice of these techniques mentioned above states the Harvard Health Blog (Corliss, 2014). Conclusion For those experiencing GAD, unproductive worries, catastrophizing, the anxiety of uncertainty and negative self-talk may be positively altered by CBT through countering method techniques and mindfulness meditation techniques (Corliss, 2014).

The practices can help one with GAD to distinguish between a negative distractive thought and a solution-based thought, which is appropriate, says Corliss. For adults with GAD, the United States Department of Health and Human Services, (National Guideline Clearinghouse, 2011), suggests to adjust the techniques to the client’s level of cognition, provide written copies of all-inclusive instructions of the technique utilized, if appropriate provide information to the family or caregiver if the client has agreed and signed documentation.

Additionally, some counselors may offer information about local support groups or classes such as yoga and tai chi. They also state to be aware of comorbid disorders such as depressive disorders, substance use, medical conditions and past treatments and responses to past treatments if applicable. GAD is a treatable disorder, however it should be noted according to the NGC, that some might need additional help and should be referred to a medical doctor for possible medication treatment in conjunction with the CBT and counseling.

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