AAPB White Paper
Generalized Anxiety Disorder in Baltimore, MD
Paula Bram Amar, Ph.D.

Anxiety Disorders, according to the DSM-III-R, are the most frequently observed category of emotional disorder in the American population. Anxiety is understood to mean a chronic persistent sense of uneasiness or dread, accompanied by distinct changes in physiology, and frequently accompanied by avoidance behavior. Some anxiety is situation based or focused on particular events or objects (phobia); other anxieties may focus on a particular set of thoughts or actions (obsessions), or be rooted in a past event (post traumatic stress). Panic tends to be more physiologically focused and may appear with or without fear of public places (agoraphobia). The most common of the anxiety disorders is Generalized Anxiety Disorder, although actual figures on its prevalence are not available.

The essential feature of this disorder is pervasive tension or apprehension with no distinguishable stressor. When anxious, the person experiencing the anxiety shows many signs of physiologic arousal in the form of muscle tension, autonomic hyperactivity, and vigilance and scanning.

The symptoms of muscle tension may include trembling, twitching or feeling shaky. There may be feelings of muscle soreness, aches and pains, restlessness and easy fatigability. Symptoms of autonomic hyperactivity may include shortness of breath, palpitations, accelerated or irregular heart rate, sweating or cold and clammy hands, dry mouth, dizziness, nausea, diarrhea, flushes or chills, frequent urination, and trouble swallowing or a "lump in the throat". Symptoms of vigilance and scanning may include feeling keyed up and on edge, exaggerated startle response, difficulty concentrating or the mind going blank, difficulty falling or staying asleep, and irritability.

Generalized Anxiety Disorder may occur in adults of any age, children or adolescents but is most common in young adults. Treatment for Generalized Anxiety Disorder most frequently combines modalities and may include anti-anxiety medication. Behavioral treatment offers an alternative to such medications, particularly for patients who do not respond well, or who have a potential for dependency on medication. Biofeedback training is a part of the behavioral treatment plan because it offers a non-pharmacologic approach to direct symptom reduction and can be used in a manner specific to the individual patient's psychophysiologic profile. For example, those patients experiencing symptoms of muscle tension would be treated with EMG (electromyographic) biofeedback to reduce their muscle tension. Those individuals whose symptoms are autonomic would most often receive thermal (peripheral temperature) or heart rate training. An EEG or a skin conductance (EDR or GSR) component may be added, if assessment documents dysregulation in these areas. Biofeedback training is generally preceded by a variety of relaxation training exercises.

Behavioral treatment may also include cognitive interventions identify negative thinking, and to develop more appropriate assessment of life events. Where specific fears can be identified, behavioral fear reduction techniques such as desensitization, modeling, or flooding may be utilized.

Most studies document improvement and significant symptom reduction in 6 to 12 sessions, with more complex or chronic patients requiring a longer treatment process. Like most behavioral treatments, biofeedback is most effective with patients who are willing to take an active role in the treatment process.

In summary, Generalized Anxiety Disorder (GAD) refers to a pervasive tension or apprehension which often interferes' with the quality of everyday life. Because GAD is often marked by specific physiological dysregulation, biofeedback is often considered one part of the multi-modal behavioral treatment approach. Such an approach is generally brief, cost effective, and avoids risk of dependency upon medication. It requires willingness on the part of the patient to participate in the treatment process, including compliance with home practice.

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