Generalised anxiety disorder is a common chronic anxiety disorder that affects twice as many women as men (Brawman-Mintzer, & Lydiard, 1997). As the name implies, it is characterised by worry that is excessive and unrealistic and lasts more than six months. Long-lasting anxiety is not focused solely on one specific object or situation, however in adults the anxiety may focus on issues such as health, money and career.

In addition to chronic worry, GAD symptoms can include trembling, muscle aches, abdominal upsets, dizziness, and irritability. Because of persistent muscle tension and physical anxiety reactions, they may develop headaches, heart palpitations, and insomnia. These physical complaints, combined with the intense, long-term anxiety, make it difficult to cope with normal daily activities. People with this disorder often feel afraid of something but are unable to pinpoint the specific fear. They fret constantly and have a hard time controlling their worries.

A person suffering from GAD generally exhibits a constant mood state of anxious apprehension, and worry that they can’t control (Butcher, Mineka & Hooley, 2005). The uncontrollable nature of this worry leads to avoidance of events due to anticipated negative outcomes from such events.

It leaves individuals who suffer from this disorder continually upset and discouraged. Sufferers typically spend over half of their average day worrying, with up to 90% realising that their worries are excessive (Sanderson, & Barlow, 1990). It appears that sufferers may intentionally use worry as a strategy for dealing with anticipated negative events, whereby they may superstitiously believe that by preparing for every possible outcome they can avoid disaster.

A common feature of the GAD sufferer’s cognitions is a perceived vulnerability (something will go wrong) combined with a perceived lack of coping skills (I won’t be able to cope when things do go wrong).

Source: www.mentalhealthacademy.com.au

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Behaviour therapy had its beginnings in the early 1900’s and became established as a psychological approach in the 1950s and 1960s. At this time, it received much resistance from the current school of thought, psychoanalysis.

There have been a number of people that that have contributed to the development of behavioural therapy:

Ivan Pavlov (1849 – 1936)
Pavlov’s contributions to behavioural therapy were accidental. He was originally studying the digestive process of dogs when he discovered that associations can develop when pairing a stimulus (food) that has a response (dog salivates) with a stimulus that has no response (bell).  The stimulus with no response (bell) eventually develops the same response (dog salivates) as the stimuli that has the response (food). This type of learning is known as classical conditioning (Seligman, 2006). 

John B. Watson (1878 – 1958)
Watson has been described as the “father” of behaviourism (McLeod). He used Pavlov’s principles of classical conditioning as well as emphasizing that all behaviour could be understood as a result of learning. Watson’s research involved the study of a young child called “Albert”. “Albert” was initially not scared of rats. However, Watson paired the rat with a loud noise and this frightened “Albert”.

After this was repeated numerous times, “Albert” developed a fear of rats. He also developed a fear of things similar to a rat such as men with beards, dogs, and fur coats. This fear was extinguished after a month of not repeating the experiment (McLeod, n.d.a).

B.F. Skinner (1904 – 1958)
Skinner developed the theory of operant reinforcement theory which is the notion that how often a behaviour is executed depends on the events that follow the behaviour (Seligman, 2006). For example, if the behaviour is reinforced, the behaviour is more likely to be repeated. He emphasised observable behaviour and rejected the notion of “inner causes” for behaviour (McLeod, n.d.a)

John Dollard (1900 – 1980) & Neal Miller (1909 – 2002)
Dollard and Miller provided more understanding to behavioural theory. They believed that when a stimulus and response are frequently paired together and rewarded, the more likely it is for an individual to repeat the behaviour (Seligman, 2006). They identified this as a habitual response. Dollard and Miller also identified four elements in behaviour: drive, cue, response, and reinforcement (Seligman, 2006)

Joseph Wolpe (1915 – 1977)
Wolpe described a process known as reciprocal inhibition which is when “eliciting a novel response brings about a decrease in the strength of a concurrent response” (Seligman, 2006). Wolpe also developed the therapeutic tool of systematic desensitization which is used in the treatment of phobias (to be discussed further down).

Albert Bandura (1925)
Bandura applied the principles of classical and operant conditioning to social learning. Basically, people learn behaviours through observation of other’s behaviour, also known as modelling (Seligman, 2006).

Current Focus
The traditional behavioural approach is no longer used as it once was. It has moved towards a more collaborative treatment with cognitive therapy and as such this has meant a more applicable approach (Seligman, 2006)

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There are hundreds of personality traits and tendencies that make a person acceptable for a successful long-term relationship. But according to relationship expert, Dr. Neil Clark Warren, there is one trait that is more important than all others. “Mastering verbal intimacy is the most important indicator of whether a person is right for you and ready for a serious relationship,” he says.

For the person who is dating and seeking a partner with whom to pursue a successful relationship, there is no more important task than determining if your current date has the ability to share themselves verbally on a deep and intimate level.

Dr. Warren emphasises “verbal” intimacy, the sharing of our deepest fears, dreads, joys, and inner experiences, as a great way to learn about the inner workings of our potential or current partners. He also shares three things which must be present for true verbal intimacy to begin and flourish.

You must know who YOU are. Many adults, and especially men, are complete strangers to themselves. When asked to describe their feelings on certain subjects, they are unable to answer, practically unable to even understand the question. This kind of numbness often starts in childhood when boys are told to “act like a man” or to “stop crying” because “you’re not hurt.”

These messages tell boys to ignore their inner signals. Over many years, these individuals will become oblivious to what they are feeling. To be able to share yourself deeply you must know what you’re feeling. It is vital that you understand yourself in order to develop the capability to be an equal partner in a satisfying, verbally intimate relationship.

You must have a desire to know each other. We all know certain individuals that seem fixated on themselves. These narcissists may momentarily ask an inane question about you and your life, but they quickly direct the conversation back to their accomplishments. This tendency is also often a result of a childhood imbalance.

If they grew up in a home where no one really seemed interested in them, they may have developed into adults that love to talk about themselves.  They constantly seem to be in the ‘me’ box. When you meet someone who has a great desire to sit and actively listen to you talk about yourself, this is an excellent sign that this person may well be a promising partner in the development of verbal intimacy.

You must make space for verbal intimacy. Dr. Warren explains that he is sure that verbal intimacy is most likely to flourish when “stress is low, relaxation is high, and the phone is off.” No one needs to be reminded about how cell phones, pagers, and computers have made it easier for us to carry work home and elsewhere. Time that used to be personal time by default can now be turned into work time.

For verbal intimacy to grow, the frantic pace of our lives must be slowed. We must make time for long walks and quiet dinners. Sometimes we feel guilty for making this space in our schedules, but no relationship can become a brilliant one without a dedication to the verbal intimacy concept.

A relationship can start without verbal intimacy. It can continue for months and sometimes years without either partner giving time or consideration to its benefits. However, over time almost every relationship will go flat - that is, lose its spontaneous excitement, unless both partners commit to enhancing their verbal intimacy.

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Strategic therapy involves the therapist designing specific approaches to each of the presenting issues. Symptoms and problems are viewed as a couple’s dysfunctional way of communicating and specific strategies are used to alleviate these problems. The strategic therapist places great emphasis on the sequence of interactions between couples. Sequence of interactions refers to habitual ways in which the couple behaves with one another.

For example: when one spouse speaks, does the other spouse interrupt or reject what is being said?  By identifying the relevant sequence of interactions, the therapist can develop strategic interventions that target the problem. This style of therapy is action oriented and the therapist takes full responsibility for influencing the outcomes of the therapy (Long & Young, 2007; Brown & Brown, 2002).

The model employs a mix of two styles of directives; therapy inspired and client inspired. The therapist inspired directive is where the therapist encourages the client to try an action or idea that the therapist has developed either through coaching or as a form of advice.

A client inspired directive on the other hand refers to the therapist encouraging the client to try an action or an idea that the client has developed. Overall, the therapy recognises the importance of a quality therapeutic alliance in order to achieve desired outcomes.

According to strategic therapy, problems in relationships develop in three ways. The first way is through the cybernetic process. Thisrefers to challenges being turned into chronic problems if they are not appropriately resolved.

The second way problems are seen to develop in relationships is structural whereby problems are seen as a result of displaced hierarchies in the family. For example, when conflict between a husband and wife increases, a wife may get closer to her son and begin to ignore the husband.

The third way problems are seen to develop in relationships is functional whereby problems are seen to develop in relationships when people try to protect or control one another covertly (Nichols & Schwartz, 2004). The ultimate aim of strategic therapy is centralised around helping couples define clear goals, problem solve, reorganise the family hierarchy, structure and improve communication.

Assumptions of the Strategic Model

1. Problems and functions must be considered within the interactional context in which they occur.
2. Emphasis is on the sequence of interaction between couples
3. Emphasis is on the present and not the past. The history of the couple is irrelevant as the dysfunctional behaviour is
4. believed to be maintained by current interactions.
5. Insight is not viewed as a vital component of change.

(Long & Young, 2007; Brown & Brown, 2002)

Goals of Strategic Therapy

1. Define clear and achievable goals.
2. Change behavioural responses to problems.
3. Improve problem solving skills.
4. Reorganise and Improve communication.

(Adapted from: Nichols & Schwartz, 2004)

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People with panic disorder suffer severe attacks of anxiety which can make them feel as though they are having a heart attack or are going crazy. Symptoms include heart palpitations, chest pain or discomfort, sweating, trembling, dizziness, difficulty breathing and feelings of losing control.

Panic disorder involves at least one of these attacks followed by a month or more of persistent concern about either a) having another attack, b) worry that the attack means he or she is going crazy or has severe health problems, or c) a significant change in behaviour as a result of the attack (e.g. avoiding places where an attack might occur).

The American Psychiatric Association (2000) defines a panic attack as fear or discomfort that arises abruptly and peaks in 10 minutes or less, and can occasionally last for hours. They are usually unpredictable, and this can lead a sufferer to avoid certain places or situations where a panic attack may occur and from where escape would be difficult or embarrassing.

There are three types of panic attacks:

1. Spontaneous (uncued) panic attacks: These forms of attack seem to come “from out of the blue” and are not triggered by any situation in particular. They tend to occur during period of sleep or when relaxing.
2. Situational (Cued) panic attacks: Occur mostly in a situation where a previous attack has occurred.
3. Situational pre-disposed panic attacks: While being pre-disposed to having a panic attack in a certain situation, the person may or may not have an attack either in the situation or immediately afterward (http://www.panicanxietydisorder.org.au Retrieved 23 July 2009).

Although panic attacks sometimes seem to occur out of nowhere, they generally happen after frightening experiences, prolonged stress, or even exercise. Many people who have panic attacks think they are having a heart attack and often end up at the doctor or emergency department.

Even if tests show nothing out of the ordinary, the person will still worry, and this further elevates their anxiety levels. Marcks, Weisberg and Keller (2009) suggest that individuals with panic disorder experience considerable impairment and disability including occupational difficulties, impaired wellbeing and reduced quality of life.

Heightened awareness, referred to as hypervigilance, with regard to any change in the normal function of the human body, will be noticed and misinterpreted as a possible life threatening illness. Normal changes in heartbeat, such as when climbing a flight of stairs or after exercise, are often interpreted by someone who has recently experienced a panic attack as an impending heart attack or the onset of another panic attack. Some sufferers worry so much they may leave their job or refuse to leave home to avoid future attacks. This can lead to a diagnosis of panic disorder with agoraphobia. 

The Panic Cycle:

1. Perceived Threat
2. Apprehension or worry (about having a panic attack or about distressing situation) 
3. Body sensation (e.g. heart palpitations, chest pain or discomfort, sweating, trembling, dizziness)
4. Interpretation of sensations as catastrophic

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