Abnormal Psychology

Anxiety Disorders 261

Figure 7.5

7.5 • Feedback Loops

in Treating Generalized

Anxiety Disorder

Changes neural

activity

Treatments Targeting

Neurological Factors

Medication: Buspirone,

SSRIs, SNRIs

Treatments Targeting

Social Factors

Changes social

interactions

Treatments Targeting

Psychological Factors

Changes thoughts,

feelings, and

behaviors

CBT: Breathing retraining,

muscle relaxation,

worry exposure,

cognitive restructuring,

self-monitoring,

problem solving,

psychoeducation,

meditation

FEEDBACK LOOPS IN TREATMENT: Generalized Anxiety Disorder

Muscle relaxation training involves increasing the patient’s awareness of muscle tension

(psychological factor) and then using techniques to decrease that tension; this pro-

cess leads to neurological changes (neurological factor), particularly when it reduces

stress and thereby decreases the levels of stress hormones. In turn, as other behavioral

methods and cognitive methods (psychological factors) reduce worry and anxiety, the

patient can devote his or her attention to other matters, including relationships and

work (social factors). For instance, with A. H. (the woman in Case 7.1), treatment con-

sisted of psychoeducation, self-monitoring, exposure, and cognitive restructuring. Suc-

cessful treatment also affected social factors: Her children found her “less moody” and

“more fun to be with” (Brown & Barlow, 1997, p. 15). Thus, when behavioral meth-

ods and cognitive methods are successful, the individual develops a sense of mastery of

and control over worries and anxiety (which decreases anxiety even further), and social

interactions reinforce new behaviors. Similarly, medication directly targets neurological

factors, which in turn reduces the individual’s worries and anxiety; he or she becomes

less preoccupied with these concerns, which increases the ability to focus at work and in

relationships. These feedback loops are illustrated in Figure 7.5.

Did Earl Campbell develop GAD? Although his worries may seem excessive

and uncontrollable at times, they do not appear to have had the effects neces-

sary for the diagnosis, such as muscle tension, irritability, or diffi culty sleeping

(Criterion C, Table 7.1). Any irritability or sleep problems he had are better

explained as symptoms of another anxiety disorder—panic disorder, which we

discuss in the following section.

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