Generalized Anxiety Disorder

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

What is GAD?

The DSM-5 Manual describes Generalized Anxiety Disorder (GAD) as a “persistent or excessive anxiety…about various domains…that the individual finds difficult to control” (American Psychiatric Association, 2013, p190).  Additionally, the persistent worry associated with GAD includes symptoms of restlessness, perpetual fatigue, irritability, and difficulty concentrating (American Psychiatric Association, 2013).  GAD involves a generalized anxiety that is unrelated to a specific stressor and is psychogenic in nature (Lambert & Kinsley, 2011; Preston, et al, 2013).  In this respect, while GAD’s symptoms have a neurochemical basis, they are a byproduct of nonspecific and imagined threats (Lambert & Kinsley, 2011; Preston, et al, 2013).

Therapy for GAD

It is important to understand that the mental state of GAD involves a chronic anxiety that involves an ongoing prediction that life events are unpleasant and potentially threatening.  For this reason, CBT, meditation, and motivational interviewing techniques are helpful in individuals with GAD (Greene, 2013; Preston, et al, 2013).   This can a allow clients to overcome any ambivalence while developing tools for self-soothing and learning how to rethink about one’s situation (Greene, 2013; Preston, et al, 2013).

Medications for GAD

Medications for GAD can include SSRI’s, Benzodiazepine, Busprione, and Gabapentin (Greene, 2013; Preston, et al 2013). Benzodiazepine acts on GABA receptors that cause the opening of calcium channels, and inhibition of the neuron (Preston, et al, 2013).  Busprione, in contrast acts on serotonin receptors, and while less addictive than Benzodiazepine, its action is delayed (Greene, 2013).  Finally, the anticonvulsant Gabapentin is also used for anxiety.  Originally designed to mimic GABA, Gabapentinis thought to prevent the release of monoamines (Greene, 2013).

Preston, et al, (2013) suggest that since the half-life of anxiolytics tends to be short, the tendency for withdrawal is high.  Additionally, some of these medications have a high risk for addiction.  Patient education of these risks and other potential side effects, is important.  Finally, in order to minimize withdraw, it is important to closely monitor a client’s response to the gradual tapering of dosage levels (Preston, et al, 2013).

Therapist’s Role

In the first week of class, we read several resources that discussed the importance of a multidimensional, biopsychosocialperspective of mental health.  In addition to attaining a comprehensive experiential background, it will be important to collaborate one’s efforts with individuals in other mental health fields  For example, while therapist’s do not prescribe medication, they will need to be aware of what the client is taking.  An understanding of the effects of these medications is essential for properpsychoeducation and their effects on a patient’s overall well-being is also important.  In the case of the anxiolytics, Preston, et al, (2013), suggests that they work best as a short-term solutions.   For this reason, a therapist’s role will involve many of the therapeutic techniques listed above while simultaneously monitoring response to medications.

A Day in my Life

The Overview

I am a married mother to two boys, ages 14 and 8. I work full-time job as a C.N.A. for a large hospital-system float pool. I work three back-to-back 12-hour night shifts, Friday-Sunday, 7:00 p.m. to 7:00 a.m.. I have Monday thru Thursday off and spend the majority of this time on school work and family-related duties. My days vary greatly depending on whether it’s a weekend or a weekday. However, one constant issue in my life is jet-lag, due to an ongoing rotation between day-time and night-time sleep. Additionally, since my husband works 8:00 a.m. through 5:00 p.m., Monday-Friday, we rarely have a whole day to spend together. I make the most of the family time I do have in the morning and evening.

Work-Day Weekends

On the weekends when I work, my husband is home with the kids. I usually arrive home at 8:00 a.m. and have a quick breakfast with the family. I make it a goal to sleep between 9:00 a.m. and 4:00 p.m.   The sleep is usually inadequate since my kids can be noisy and frequently have friends over.   When I wake up, I work on my discussion board post responses and have dinner with my family before leaving for work around 6:30. Since I work for a hospital system float pool, the work varies greatly. Nonetheless, it is usually physically and mentally exhausting. The floors have been short-staffed quite a bit lately. This doubles my patient load from approximately 10 to 20 patients.   I often get one break during the middle of my shift at about 1:00 a.m., otherwise I’m on my feet constantly

Weekdays Off

On my weekdays off, my main goal is to recover from the weekend as quickly as possible. I reserve Monday for this purpose and don’t get much done. I wake up in the morning Tuesday, thru Friday, around 7:00 a.m. and make breakfast then get my kids to school. Since I’m home alone during the day, I try my best to complete homework, but often require a nap. I pick my kids up around 3:00 p.m., make a snack, and get dinner ready. I do my homework on the dining table while my kids after we eat. I try to get to bed between 10-11 p.m.

A Day in My Life with GAD

GAD & SWSD: A Double Whammy

The DSM-5 Manual describes Generalized Anxiety Disorder (GAD) as a “persistent or excessive….worry about various [life] domains…that the individual has difficult to control” (American Psychiatric Association, 2013, p190). Symptoms of anxiety include restlessness, perpetual fatigue, irritability, sleep disturbance, and difficulty concentrating (American Psychiatric Association, 2013). Interestingly, symptoms of GAD are fairly similar to “Shift Work Sleep Disorder” (SWSD), an issue common in night shift workers (Brett, 2005). Symptoms associated with Shift Work Sleep Disorder include: insomnia, fatigue, and difficulty concentrating (Brett, 2005). Additionally, individuals dealing with this issue are at increased risk of heart disease, obesity, anxiety and depression (Brett, 2005).  Adding a GAD to my life would significantly exacerbate the sleep disorder issues I currently deal with. Right now, I’m able to manage effectively by making adequate self-care a priority. As an individual who spends the majority of her time caring for others, I’ve had to learn to put myself first. I try my hardest to get a full 6-8 hours sleep daily. With GAD, this may become an impossible feat, and would require a simplification of my life. This would include either working less or quitting school.

Life Through The Lens of Anxiety

The important thing to note about anxiety, is that it exists independent of logic.   You can’t talk or reason your way out of it. While I don’t have an anxiety, I already have a very stressful schedule. In this respect, I can imagine its effects. For example, when I’m tired, I have difficulty utilizing my prefrontal cortex to think logically about things. As a result, the stress takes over, and I can become irrational when exhausted. I find I’m thinking with my emotions rather than through them. With Generalized Anxiety Disorder, this might occur in a more pronounced manner as the lens through which I experience life. Anxiety would become the mode of being that defines my existence. Every element of my life would become that much more unmanageable.   For example, anxiety may cause me to worry about the effectiveness of my role as a mother. Since my son has a heart condition, and my youngest came only after a miscarriage, these experiences could exacerbat GAD. I would worry about their well-being every minute of the day. The guilt I would feel about the fact that they eat too much junk food and stay up too late, may incapacitate me. Adding the responsibilities of a full time C.N.A. position and school work may prove overwhelming.   Honestly, I’m not sure if I would be able to function in my current life circumstances.

Overall, eliminating some responsibilities from my life would be the easier solution. This would involve working less or quitting school, which I would happily do for the sake of my well-being. The difficult issue regarding GAD pertains to its affect on relationships and the ability to enjoy life. My husband wouldn’t have the partner he does currently, and would need to shoulder greater responsibilities. Everybody would also have to accommodate my GAD symptoms.   Most importantly, I would be trapped inside a mind filled with anxiety while living a life defined by worry.

Raising a Child with GAD

The final question posed in this assignment is how different it might be to parent a child with GAD. As a parent to a child with a congenital heart defect, I have some insights worth mentioning. My oldest son has a congenital heart defect (CHD) called pulmonary atresia. Individuals with heart defects have what can be thought of as a “hidden disability” (CITE). While not readily visible upon initial inspection, the influences of a heart defect do require special consideration. In addition to the obvious physical limitations, there are also less obvious concerns. Social delays in males with CHD result from an inability to participate in sports, alongside prolonged stays in the hospital (Berant, et al, 2001; Horner, et la, 2000). Emotional developmental delays result from the parent-child relationship that occurs when a child is faced with a serious life-threatening illness (Berant, et al, 2001; Horner, et la, 2000).  The most difficult thing about the experience, isn’t just the heightened anxiety and worry, but also the judgment from others (Berant, et al, 2001; Horner, et la, 2000). It requires time to recover from such a trauma, and your relationship with the child is changed. Children with CHD spend a significant time fighting for their life, and don’t have the same opportunities to engage in the normal childhood developmental process. Nonetheless, people may not realize this and simply notice deviations in a child’s level of emotional regulation that are generally expected at a certain age. The hardest part is the idea of wanting to support your child by giving what they need developmentally, in a world that judges them for unpalatable behavior.   While this issue, doesn’t compare to parents of children with a serious mental health issue, this experience has enabled me to develop greater understanding and compassion.

References

American Psychiatric Association. (2013).  Diagnostic and statistic manual of mental disorders.  (5th ed.).  Washington, D.C.: Author.
Berant, E., Mikulincer, M., & Victor, F. (2001). The association of mothers’ attachment style and            their psychological reactions to the diagnosis of infant’s congenital heart disease. Journal =of Social and Clinical Psychology, 20(2), 208-232.
Brett, A. S. (2005). Modafinil for shift-work sleep disorder. NEJM Journal Watch General Medicine, doi:http://dx.doi.org/10.1056/JW200508260000004
Greening, L. (2013). Generalised anxiety disorders. The Dissector, 41(2), 30-32. Retrieved fromhttp://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/1462047083?accountid=28125
Horner, T., Liberthson, R., & Jellinek, M. S. (2000). Psychosocial profile of adults with complex congenital heart disease. Mayo Clinic Proceedings, 75(1), 31-6.
Lambert, K., & Kinsley, C.H. (2011). Clinical neuroscience: The neurobiological foundations of mental health. 2nd Ed., New York, NY: Worth Publishers
Preston, J.D., O’Neal, J.H., & Talaga, M.C. (2013). Handbook of clinical psychopharmacology for therapists (7th Ed.)  Oakland, CA: New Harbinger Publications, Inc
Vrijmoet-Wiersma, ,J.C.M., Ottenkamp, J., van Roozendaal, M., Grootenhuis, M. A., & Koopman, H. M. (2009). A multicentric study of disease-related stress, and perceived vulnerability, in parents of children with congenital cardiac disease. Cardiology in the Young, 19(6), 608-14.

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