Life Experiences of Patients with Generalized Anxiety Disorder (GAD) Comorbid with Emotional Disorders: A Qualitative Study

Document Type : Original Article

Authors

1 PhD in Psychology, Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan. Iran

2 Assistance Professor, Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan. Iran

3 Associate Professor, Department of Children with Special Needs, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran

Abstract

Introduction: A deeper understanding of generalized anxiety disorder (GAD) provides many clues to what causes anxiety disorders and what treatment is needed. The present study aimed to investigate the life experiences of patients with GAD comorbid with emotional disorders.
Methods: The present research was a qualitative one carried out based on the phenomenological approach. The participants in the study were 10 patients with GAD comorbid with emotional disorders who were selected using purposive sampling method based on data saturation. A semi-structured face-to-face interview was used to collect data. The texts of the interviews were analyzed by the phenomenological approach using Colaizzi’s seven-step method.
Results: The results of analysis of data derived from the interviews revealed four main themes and 13 subthemes including components of illness (worry, cognitive component, behavioral component, emotional component, physiological component), influential factors (sociocultural factors, psychological vulnerability, developmental history), consequences of illness (quality-of-life impairment, interpersonal problems), and treatment (self-care, expectations of treatment, limitations and barriers to treatment .(
Conclusion: The themes identified in this study by phenomenological method based on lived experiences of patients provided new information about the etiology, consequences, and treatment of this disorder.

Keywords


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    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen 2005; 62(6):617-27. doi: 10.1001/archpsyc.62.6.617.
    2. Bower ES, Wetherell JL, Mon T, Lenze EJ. Treating Anxiety Disorders in Older Adults: Current Treatments and Future Directions. Harv Rev Psychiatry. 2015; 23(5):329-42. doi: 10.1097/HRP.0000000000000064.
    3. Newman MG, Przeworski A. The increase in interest in GAD: Commentary on Asmundson & Asmundson. J Anxiety Disord. 2018; 56:11-13. doi: 10.1016/j.janxdis.2018.04.006.
    4. Bobes J, Caballero L, Vilardaga I, Rejas J. Disability and health-related quality of life in outpatients with generalised anxiety disorder treated in psychiatric clinics: is there still room for improvement? Ann Gen Psychiatry. 2011; 10(1):7. doi: 10.1186/1744-859X-10-7.
    5. Roberge P, Normand-Lauzière F, Raymond I, Luc M, Tanguay-Bernard MM, Duhoux A, Bocti C, et al. Generalized anxiety disorder in primary care: mental health services use and treatment adequacy. BMC FAM Pract. 2015; 16:146. doi: 10.1186/s12875-015-0358-y.
    6. Millstein DJ, Orsillo SM, Hayes-Skelton SA, Roemer L. Interpersonal Problems, Mindfulness, and Therapy Outcome in an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder. Cogn Behav Ther. 2015; 44(6):491-501. doi: 10.1080/16506073.2015.1060255.
    7. Mohammadi MR., Pourdehghan P, Mostafavi SA, Hooshyari Z, Ahmadi N, Khaleghi A. Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. J Anxiety Disord. 2020; 73:102234. doi: 10.1016/j.janxdis.2020.102234.
    8. Newman MG, Przeworski A, Fisher AJ, Borkovec TD. Diagnostic comorbidity in adults with generalized anxiety disorder: Impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses. Behav Ther. 2010; 41(1):59-72. doi: 10.1016/j.beth.2008.12.005.
    9. Wittchen HU. Generalized anxiety disorder: Prevalence, burden, and cost to society. Depress Anxiety. 2002; 16(4):162-71. doi: 10.1002/da.10065.
    10. Blanco C, Rubio JM, Wall M, Secades-Villa R, Beesdo-Baum K, Wang S. The latent structure and comorbidity patterns of generalized anxiety disorder and major depressive disorder: a national study. Depress Anxiety. 2014; 31(3):214-22. doi: 10.1002/da.22139.
    11. Khani M, Dadashi M, ghoreishi A. Comparison of brain/behavioral system activity, intolerance of uncertainty and cognitive avoidance among individuals with generalized anxiety disorder and normal subjects. J Adv Med Biomed Res. 2017; 25(111):67-81. [In Persian].
    12. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th Ed). New York: Wolter Kluwer; 2015.
    13. Shihata S, McEvoy PM, Mullan BA. Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms. J Anxiety Disord. 2017; 45:72-9. doi: 10.1016/j.janxdis.2016.12.001.
    14. Coussement C, De Longueville X, Heeren A. Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits. Compr Psychiatry. 2022;113:152294. doi: 10.1016/j.comppsych.2021.152294. 
    15. Ranta K, Kaltiala-Heino R, Pelkonen M, Marttunen M. Associations between peer victimization, self-reported depression and social phobia among adolescents: the role of comorbidity. J Adolesc. 2009; 32(1):77-93. doi: 10.1016/j.adolescence.2007.11.005.
    16. Kashdan TB, Roberts JE. Comorbid social anxiety disorder in clients with depressive disorders: Predicting changes in depressive symptoms, therapeutic relationships, and focus of attention in group treatment. Behav Res Ther. 2011; 49(12):875-84. doi: 10.1016/j.brat.2011.10.002.
    17. Kessler RC, Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004; 13(2):93-121. doi: 10.1002/mpr.168.
    18. Saha S, Lim CCW, Cannon DL, Burton L, Bremner M, Cosgrove P, … & McGrath J. Co-morbidity between mood and anxiety disorders: A systematic review and meta-analysis. Depress Anxiety. 2021; 38(3):286-306. doi: 10.1002/da.23113.
    19. Showraki M, Showraki T, Brown K. Generalized anxiety disorder: Revisited. Psychiatr Q. 2020; 91(3):905-14. doi: 10.1007/s11126-020-09747-0.
    20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th Edition, Text Revision. Washington, DC: American Psychiatric Association; 2022.
    21. Hackmann C, Balhara YPS, Clayman K, Nemec PB, Notley C, Pike K, Reed GM, Sharan P, Rana MS, Silver J, Swarbrick M, Wilson J, Zeilig H, Shakespeare T. Perspectives on ICD-11 to understand and improve mental health diagnosis using expertise by experience (INCLUDE Study): an international qualitative study. Lancet Psychiatry. 2019; 6(9):778-785. doi: 10.1016/S2215-0366(19)30093-8.
    22. Clissett P. Evaluating qualitative research. Journal of Orthopaedic Nursing 2008; 12(2):99-105. doi: 10.1016/j.joon.2008.07.009.
    23. ‏Guba EG, Lincoln YS. Fourth generation evaluation. Thousand Oaks, CA: Sage Publications; 1989.
    24. Macnee CI. Understanding nursing research: Using research in evidence-based practice. Philadelphia: LWW Publications; 2004.
    25. Polit DF, Beck CT, Hungler BP. Nursing Research: Principles and methods. 7thed. Philadelphia: LWW Publications. 2004.
    26. Varela RE, Sanchez-Sosa JJ, Biggs BK, & Luis TM. Anxiety symptoms and fears in Hispanic and European American children: Cross-cultural measurement Journal of Psychopathology and Behavioral Assessment. 2008; 30(2):132-45. doi: 10.1007/s10862-007-9056-y.
    27. Zarani F, HaghighiF, Alizade H, Shiri E. The role of culture in the dimensions of anxiety disorders based on DSM-5. Cultural Psychology. 2017; 1(2):95-111. [In Persian].
    28. Hiedari A, Meshkinyazd A, Soodmand P. Broken Personality: Lived experiences of patients with psychiatric disorders on self-stigma. J Qual Res Health Sci. 2020; 9(3): 221-28. doi: 10.22062/jqr.2020.91515.
    29. Vries J, Stein DJ, Kamuya D, Singh, I. Psychiatric genomics: Ethical implications for public health in lower-and middle-income countries. The American Journal of Bioethics 2017; 17(4):17-19. doi: 1080/15265161.2017.1284938.
    30. Batterham PJ, Griffiths KM, Barney LJ, Parsons A. Predictors of Generalized Anxiety Disorder stigma. Psychiatry Res. 2013; 206(2-3):282-6. doi: 10.1016/j.psychres.2012.11.018.
    31. Eskandari H, Farid Hosseini F, Khalili S. Symptomatology of anxiety disorder in visitors to tehran medical centers with emphasis on iranian culture. [Dissertation]. Tehran: Allameh Tabatabai University; [In Persian].
    32. Dugas MJ, Robichaud, M. Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. London, UK: Routledge; 2012.‏
    33. Beach SR, Wamboldt MZ, Kaslow NJ, Heyman RE, Reiss D. Describing relationship problems in DSM-V: toward better guidance for research and clinical practice. J FAM Psychol. 2006; 20(3):359-68. doi: 10.1037/0893-3200.20.3.359.
    34. Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry. 2005; 62(12):1377-84. doi: 10.1001/archpsyc.62.12.1377.
    35. Zarean M. Dimensions of depression and anxiety in Iranian culture [dissertation]. Tehran: Shahid Beheshti University; 2015. [In Persian].