Individual Psychology and Cognitive-Behavioral Approaches to Generalized Anxiety Disorder
This paper was written to address the differing perspectives of two therapy frameworks and their effectiveness for treating GAD.
According to the American Psychiatric Association (APA), Generalized Anxiety Disorder (GAD) is indicated by extreme worry, disproportional to the actual threat the situation presents, over a range of topics stemming from a fear of uncontrollability, to the point where daily functioning is impaired (2013). To be diagnosed with GAD, a person must display designated symptoms for the majority of six or more months (APA, 2013). Such criteria may include what the APA (2013) calls apprehensive expectation, which is the anxiety individuals feel towards upcoming activities. What’s more, these people feel they cannot control their worry which may bring about restlessness, fatigue, irritability, strained muscles and trouble maintaining focus or sleep (APA, 2013). To be diagnosed, adults must report three of the previous symptoms and considerable distress (APA, 2013). Worry saps time and energy, so these people can have trouble doing things quickly and effectively (APA, 2013). Finally, those with GAD experience such impairments not as a result of another medical or mental condition or use of a substance (APA, 2013).
GAD may be distinguished from regular anxiety because the chronic worry comes with little prompt and physical symptoms (APA, 2013). These may range from the stress and muscle induced, headaches and shaking, to bodily arousal (APA, 2013). Having made this distinction, Kessler, Petukhova, Sampson, Zaslavsky, and Wittchen (2012) report that GAD has a yearly prevalence rate of 2.9% in adults in the United States and Lewis-Fernández et al. (2010) suggests up to 3.6% elsewhere. Interestingly, GAD is more common in females, those with a family history, from industrialized countries, and those of European lineage with a spike in middle age around thirty (APA, 2013). Earlier onset is related to greater impairment and comorbidity with other disorders.Children are at risk if they show perfectionism, anxiety even without evaluation, and worry about being on time (APA,2013). GAD is generally expressed similarly across age groups but differs somatically by culture(APA, 2013).
A branch of the psychodynamic perspective, Individual Psychology by Alfred Adler, focuses on the ways by which childhood and the strive for superiority bring about dysfunction (Tom, 2019). By this view, it makes sense that perfectionist children fearing evaluation and uncontrollability are at risk because they suffer from an inferiority complex. Adler (1927) states that anxiety in a child may result from a spoiling parent that does not give the child space to gain individuality. Individuality is key to Adler as he sees each person as unique. He would say the perfectionism of those with GAD comes from wanting to feel superior and accomplished (Adler, 1927). Pervasive worrying about control and the future thus stem from feeling inferior and lacking self-esteem to believe that you can get bigger, stronger, and complete (Tom, 2019).
Therefore, GAD to Adler is the result of an inferiority complex stemming from childhood circumstances. To treat GAD, Adler would promote independence, rationale, and a sense of control (Adler, 1927). His therapy is kind and active, so he’d help the person, perhaps through emphasizing their uniqueness and rational thoughts, overcome their sense of inferiority presented as apprehensive expectation and over-compensative, excessive worry(Tom, 2019). According to Bolognesi, Baldwin, and Ruini (2014), “brief Adlerian psychodynamic psychotherapy” is the most effective psychodynamic approach to relieving symptoms of GAD. This too aims to improve a patient’s self-efficacy and esteem by focusing on their needs (Bolognesi et al., 2014). Therapy under Adler’s perspective proved to alleviate GAD symptoms by itself for a year or more (Bolognesi et al., 2014).
Bolognesi et al. (2014) also evaluated the use of Cognitive-Behavioral Therapy (CBT) for treating GAD as it is considered the most effective approach for the disorder. CBT is at such an advantage because it has treatment manuals specifically made to target this disorder based on empiricism (Todd & Bohart, 2006). Besides relying on proven techniques, this perspective is known for incorporating both cognitive and behavioral components, with an emphasis on the behavioral (Deacon & Abramowitz, 2004). Thus, an explanation for the onset of GAD may be that the individual has adopted a maladaptive or distorted way of thinking (cognitive) or was conditioned through avoidance(behavioral)(Deacon & Abramowitz, 2004). GAD progresses with the frequency and severity of such distortions as catastrophizing. For example, a patient may believe that one job failure will bring about the end of their career in a series of ‘what ifs.’
To break the spiraling pattern of anxiety with CBT, Llera and Newman (2015) would begin by having the client self-monitor their situation to identify triggers and signals of an impending episode. Should the overwhelming anxiety state begin, a person would be instructed to use relaxation skills such as deep breathing or progressive muscle relaxation to keep the situation from escalating (Llera & Newman, 2015). Techniques such as these, and cognitive restructuring, would be learned in a typical Cognitive-Behavioral Therapy session. Restructuring refers to the process of noticing and changing unhelpful thoughts so that they may become more flexible and accurate (Llera & Newman, 2015). To achieve accuracy, a client may be asked to challenge their worries against the likelihood that their fears will come to fruition or their evidence for having them (Deacon & Abramowitz, 2004).
Practice is key to CBT. In Generalized Anxiety Disorder, it can be utilized with imaginal exposure and self-control desensitization which ask the patient to think of their worst-case scenario and triggering events respectively (Kaczkurkin & Foa, 2015; Llera & Newman, 2015). In using either of these, a patient becomes more used to their fears so that worry loses power via habituation. This is beneficial according to CBT as previously held thought distortions can make a person feel vulnerable even as they hold onto the feeling that worry is a good thing (Deacon & Abramowitz, 2004; Llera & Newman, 2015). Therefore, the therapist acts as a teacher and may use this psychoeducational approach to help somebody with GAD come to see that worrying is not good for them (Llera & Newman, 2015).
Reflected in the length dedicated to describing each perspective, Individual Psychology is a much older theorization with fewer publications than Cognitive-Behavioral Therapy. This is in part due to the emphasis CBT places on experimental evidence. In turn, CBT has developed the most effective interventions for GAD and would likely be recommended over Individual Psychology, even though they have both been shown to improve anxiety symptoms (Bolognesi et al., 2014). Bolognesi et al. (2014) supports this claim with evidence that CBT led to less anxiety and more remission for GAD than other therapies such as psychodynamic or medication. Todd and Bohart (2006) also report CBT to be more effective than its nondirective counterparts.
Perhaps both are at least partially effective due to a shared focus on rationality (Tom, 2019). Other commonalities are found in valuing active therapy, the therapeutic relationship, self-affirmation, mastery, and congruence (Kubacki & Chase, 1998). However, the dose of each ingredient still varies between the two.CBT, for instance, places a greater emphasis on control to help the individual fit into society whereas Individual Psychology prefers self-affirmation and exploration of the subjective (Kubacki & Chase, 1998). These distinctions are present in each approach’s claimed source of dysfunction. For example, CBT works with thoughts of the present while Individual Psychology explores childhood and the inferiority complex. Such divisions likely arose with the vastly different theoretical roots of each perspective. CBT originated in behavioralism and Individual Psychology emerged from psychoanalysis(Tom, 2019).
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