alexa Generalized Anxiety Disorder and Depression

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Generalized Anxiety Disorder and Depression

 

Generalized Anxiety Disorder (GAD) affects a large number of people [1]. While inroads have been made in terms of its treatment, many reviewers of psychotherapeutic treatment for GAD conclude that effectiveness is far from complete and that more about GAD remains to be learned [2,3]. Two features of GAD are prominent. First, GAD is characterized by what can be called a behavioral excess. Sufferers complain of frequent and seemingly uncontrollable worry, so much so that Andrews et al. [4] recommended that the disorder be renamed “generalized worry disorder.” Second, GAD is highly comorbid with depression [5].
 
The study of GAD has reasonably focused on its prominent symptom; worry. In the clinical and scientific literature, this symptom has been treated according to either a “worry as anxiety” or “worry as avoidance behavior” hypothesis. In the current theoretical paper, the authors make the argument that the addition of a “worry as adjunctive behavior hypothesis” might help complete our understanding of the disorder. The authors summarize the main points of the current hypotheses for worry and direct the reader to representative literature in which those ideas are developed, examined, or applied. The authors next summarize learning theory literature that explains that the experiences that contribute to depression should, in many cases, give rise to small behaviors that produce immediate satisfaction (i.e., adjunctive behaviors). They argue that, in some cases, worry might best be understood as an adjunctive behavior and point to literature that is consistent with this heretofore unexpressed hypothesis.
 
As mentioned above, two conceptualizations have influenced learning theory-based discussion of worry and its treatment. The first conceptualization is based on classical conditioning and portrays worry as synonymous with anxiety [6]. Worry/anxiety is understood to be a conditioned response (CR) elicited by an aversive conditioned stimulus (CS) [for definitions see 7]. Scholarly interest in this “worry as anxiety” hypothesis appears to have waned in favor of the second learning theory hypothesis, discussed below; however, it may still be relevant in clinical practice. Individuals vary in the precision with which they use words to label private events [8-11]. Some individuals, who complain of worry, may be using the label to indicate what professionals would call anxiety. In such cases, the “worry as anxiety” conceptualization is appropriate.
 
Consider the following hypothetical example of “worry as anxiety”: Sally seeks intervention for distressing worry. A functional analysis reveals that worry occurs when Sally encounters stimuli related to her career and workplace. For example, the start of the workday elicits “What if I can’t get that project done properly?” Classical conditioning is typically assumed to be the process through which a neutral stimulus, like workplace, comes to take on its aversive meaning. An investigation of Sally’s history reveals many life experiences in which she encountered humiliating criticism in the workplace, or in situations that have generalized to the workplace. Workplace now elicits anxiety, manifested as worry. Treatment for worry/anxiety that fits this conceptualization requires extinguishing responding to the eliciting CS through exposure (e.g., desensitization, flooding, etc.). Treatment in Sally’s case would involve controlled exposure to workplace cues, in a safe environment.
 
Citation: Dygdon JA, Dienes KA (2014) Generalized Anxiety Disorder and Depression: A Learning Theory Connection. J Depress Anxiety 3:146. doi: 10.4172/2167-1044.1000146
 

 
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