Bakgrund: Generaliserat ångestsyndrom (GAD) är en vanlig diagnos med negativa konsekvenser såväl på individ- som samhällsnivå. För att som fysioterapeuter kunna fånga upp den här typen av patienter och då ha god kunskap om olika träningsformer som tillförlitlig behandling ansågs det fördelaktigt att undersöka det vetenskapliga underlaget för styrketräning som behandlingsmetod. Syfte: Syftet med denna litteraturstudie var att undersöka det vetenskapliga underlaget för effekten av styrketräning, i jämförelse med annan eller ingen intervention, som behandlingsmetod för att minska oros- och ångestsymtom hos vuxna mellan 18-64 år med GAD. Metod: En litteraturstudie av randomiserade kontrollerade studier där populationen var vuxna mellan 18-64 år med GAD. Sökningar genomfördes i databaserna PubMed, Cochrane, PEDro och Psycinfo. Fyra studier inkluderades och granskades sedan med PEDro. Den sammanvägda tillförlitligheten av resultatet av tre studier bedömdes med hjälp av GRADEstud. Resultat: Det vetenskapliga underlaget för styrketräning som behandling för personer med GAD är för begränsat för att kunna dra några starka slutsatser. Alla inkluderade studier visade dock på reducering av oros- och ångestsymtom, som båda är kännetecknande symtom för GAD. Konklusion: Det sammanvägda resultatet indikerar på att styrketräning skulle kunna vara en alternativ behandlingsmetod för denna patientgrupp. Mer forskning behövs dock för att kunna utvärdera effekten av styrketräning som behandling för personer med GAD. / Background: Generalized anxiety disorder (GAD) is a common diagnosis with negative consequences both on an individual and societal level. In order for physiotherapists to be able to catch these patients and then have good knowledge of different forms of exercise as reliable treatment, it was considered beneficial to investigate the scientific basis for resistance exercise training as a treatment method. Objective: The aim of this literature review was to investigate the scientific basis for the effect of resistance exercise training, in comparison with other or no intervention, as a treatment method to reduce worry and anxiety symptoms in adults aged 18-64 with GAD. Method: A literature review of randomized controlled trials where the population was adults between 18-64 years old with GAD. Searches were conducted in the databases PubMed, Cochrane, PEDro and Psycinfo. Four studies were included and reviewed with PEDro. The combined reliability of the results of three studies was assessed using GRADEstud. Results: The scientific basis for resistance exercise training as a treatment for people with GAD is too limited to be able to draw any strong conclusions. However, all included studies showed a reduction in worry and anxiety symptoms, both of which are characteristic symptoms of GAD. Conclusion: The combined results indicate that strength training could be an alternative treatment method for this patient group. However, more research is needed to be able to evaluate the effect of strength training as a treatment for people with GAD.

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The mood-as-input model of perseverative worrying is a conceptual model that has been developed to explain the perseverative aspect of worry inherent in Generalized Anxiety Disorder (GAD) (Davey, 2006a). The first objective of this study was to provide additional empirical support for the mood-as-input model of perseverative worrying. A second objective of this study was to investigate the association between perseverative worry and GAD symptoms. The final objective of this study was to assist in generating a comprehensive model of worry that incorporated unique predictors of GAD. Results indicated that unique variables, such as ‘as many as can’ stop rules and beliefs about worry, were weak predictors of perseveration, but were significant predictors of worry and GAD symptoms. Therefore, these variables may still contribute to the processes inherent in perseverative worry. Results also indicated that the catastrophic interview was an overall weak predictor of worry and GAD symptoms, suggesting that the catastrophic interview might not be the most suitable measure of perseverative worry. In summary, the current study provides mixed support for the mood-as-input model of perseverative worrying. Future research should further examine the relationship of the catastrophic interview and perseverative worry. In addition, future studies should include measures of GAD symptoms as an outcome variable when studying the mood-as-input model. Keywords: worry, GAD, catastrophic interview, meta-cognition, stop rules

Pathologische Sorgen sind ungenau definiert. Für die Behandlungsplanung bleiben wichtige Fragen offen: Welche Merkmale sind für die Unterscheidung zwischen behandlungsbedürftigen und nicht behandlungsbedürftigen Sorgen relevant? Welche Art von Sorgen muss wie behandelt werden? Und: Welche Art von Sorgen gilt es eher zu akzeptieren? Wir machen praxisnahe Vorschläge dafür, wie Sorgen mittels einer einfachen Heuristik auch vom Patienten selbst als «pathologisch» identifiziert werden können. Im Sinne eines therapeutischen Arbeitsmodells ergeben sich differentielle Bearbeitungsstrategien, je nachdem, ob es sich um wichtige oder weniger wichtige, auf lösbare oder unlösbare Probleme bezogene sowie angemessene oder überzogene Sorgen handelt. Das vorgestellte Arbeitsblatt zu den Sorgen soll vor allem die wahrgenommene Kontrolle des Patienten stärken und die Psychoedukation zur Generalisierten Angststörung erleichtern. / Pathological worries have not yet been clearly defined. As a consequence, practically relevant questions remain open: Which characteristics distinguish worries relevant for treatment from those which are not? What kind of worries has to be treated in which way? And: What kind of worries is rather to be accepted? We propose a simple rationale which helps the therapist and the patient to identify pathological worries. According to this working model, different treatment strategies result depending on whether worries are central or not, whether they relate to a problem which can be solved or not, and whether they seem proportionate or exaggerated. The presented worksheet is meant to strengthen the perceived control of the patient and to help facilitate psychoeducation for generalised anxiety disorder. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Literature Review: Anhedonia, the loss of interest or pleasure in usually pleasurable activities, is a core symptom of depression and is associated with a reduction in positive affect (PA). Repetitive negative thought (RNT) is implicated in the development and maintenance of psychiatric disorders. It has been hypothesised that RNT causally contributes to anhedonia. The aim of this review was to explore this relationship to answer two questions: Is there a relationship between RNT and anhedonia? Does RNT causally contribute to anhedonia? Review inclusion criteria were: studies using standardised measures to report a relationship between RNT and anhedonia or reduced PA. Results suggest that cross-sectional and longitudinal studies identify a relationship between RNT and anhedonia. Preliminary evidence from experimental studies shows that RNT causally contributes to anhedonia. Limitations within the field are that anhedonia is rarely measured directly or behaviourally. Future research is warranted to explore the relationship between RNT and anhedonia with a particular focus on direct and behavioural measures of anhedonia. Empirical Paper: It is hypothesised that repetitive negative thought (RNT) causally contributes to anhedonia. There is cross-sectional and longitudinal evidence of this relationship, but it has not previously been investigated directly using experimental methods. In the present study, student participants were randomly assigned to an unresolved goal (RNT) manipulation (n = 43) or resolved goal (control) manipulation (n =41) prior to completing a reward sensitivity task. This task has been reliably found to train a response bias towards the stimuli that is differentially positively reinforced, with both depression and self-reported anhedonia associated with a reduced response bias. The unresolved goal versus resolved goal manipulation was effective, with the unresolved condition producing significantly higher levels of RNT during the reward sensitivity task relative to the resolved condition. Inconsistent with study predictions, there was no significant difference between the conditions on response bias, although there were trend findings, which tentatively suggest that RNT may influence anhedonia. Potential accounts for the null findings and future research are discussed.

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