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En effectiveness-studie undersökte effekten av Dugas och Robichauds (2007) behandlingsmodell för GAD på en specialistmottagning för patienter med komplicerade ångest och eller depressionstillstånd. Utöver detta undersöktes vilka övriga KBT-behandlingar för GAD som förmedlats på mottagningen. Alla patienter behandlades som en del av klinikens ordinarie verksamhet. Huvudutfallsmått var Generalized Anxiety Disorder Scale-7 (GAD-7) som mättes före och efter behandling. Därutöver mättes även grad av depressiva besvär med PHQ-9 samt grad av klinisk remission efter behandling. Behandlingsmodellens resultat för de patienter som bidragit med eftermätning (completerdata) visade en stor inomgruppseffektstorlek för GAD-7 (Cohen’s d=1,76) och 65% bedömdes även efter behandling inte längre uppfylla kriterier för GAD enligt DSM-IV. Bortfallet av data från före- till eftermätning var dock stort, vilket försvårar tolkningen av huvudutfallsmåttet. Även moderatorer för effekt undersöktes, men inga signifikanta samband mellan behandlingsutfall och tidigare visade moderatorer för effekt såsom ålder, kön eller samtidig farmakologisk behandling kunde visas. Resultaten jämförs med tidigare studier och en diskussion förs kring studiens begränsningar. / Objective: While the efficacy of Dugas and Robichauds (2007) CBT treatment model for GAD has been tested in clinical trials, it is still unclear how the treatment is received in a outpatient setting with clinically referred patients. The present effectiveness study aimed to examine the effect of Dugas and Robichauds (2007) CBT treatment on a large outpatient group (N=188) diagnosed with GAD. In addition other types of CBT treatments delivered to the outpatient group were examined, as well as potential moderators for treatment effect such as age, sex, initial GAD-7 scores and concurrent pharmacological treatment. The treatment for the outpatient group was delivered in a clinic (WeMind, www.wemind.se) specialized in treatments of depression and anxiety.  Method: The study is an analysis of gathered data from CBT treatments of GAD during a 3 year span at the clinic. Patients (N=188) diagnosed with GAD were categorized according to type of CBT treatment received and if treatment was completed with intact data. 71 patients were treated with Dugas and Robichauds (2007) CBT treatment, but 22 of these patients also received other CBT interventions at the same time. 33 patients received other kinds of CBT treatment. A large group (N=84) had missing data or did not complete treatment. Measurements taken at the beginning and end of treatment were Generalized Anxiety Disorder scale-7 (GAD-7), Public Health Questionnaire-9  (PHQ-9) and Penn State Worry Questionnaire (PSWQ). Clinical remission was measured at the end of treatment with the help of the therapists. A completeranalysis design was used with no waitlist or control group. Results: A paired samples T-test for patients treated with Dugas and Robichauds (2007) CBT treatment and measured with GAD-7 and PHQ-9 gave significant results for GAD-7, t70=13,17 (p<0.001) and PHQ-9, t67=10,25 (P<0.001). 46 of the 71 patients (65%) was assessed with clinical remission (no clinical diagnoses after treatment). Effectsize calculated with Cohen's d were GAD-7=1.76, PHQ-9=1.46 and PSWQ=1.76. Moderators were examined by calculating GAD-7 change score (difference pre-post GAD-7) and correlating the change score with age, sex, initial GAD-7 score and pharmacological treatment. Age and sex gave no significant results. Whether concurrent pharmacological treatment had an moderator effect was examined by categorizing the patients into three groups: (1) no pharmacological treatment, (2) stable pharmacological treatment and (3) changed pharmacological treatment (increased dosage or new treatment). Again no significant effect was found. One positive significant correlation was found with initial GAD-7 scores and GAD-7 change score, GAD-7, r=.66, t69=7,36 (p<0.001). Higher initial GAD-7 measurement correlated with a greater change score. Conclusions:The results indicate a large treatment effect for Dugas and Robichauds (2007) CBT treatment model for GAD in an normal outpatient setting, with clinically referred patients and treatment administered by general CBT therapists. The effect was superior compared to the group that received general CBT treatment interventions for GAD. The effect of treatment measured with GAD-7 and PHQ-9 was also drastically improved if other CBT interventions was added to the treatment model, but these interventions did not have an effect on clinical remission. Serious limitations such as a high percentage of drop outs, a completeranalysis model, no control group and no follow up data restrict the possible interpretations of the results.

This study aims to gain an increased understanding of generalized anxiety disorder based on how the target group describe their experiences. The data was gathered through podcasts where people with GAD talked about their life situation, what strategies they use to manage general anxiety and what they think relieves general anxiety. The gathered data was then analyzed through a thematic analysis where four main themes were developed; a constant worry, managing stigma, controlling or avoiding and only relive, not cure. These themes were analyzed based on Goffman's theory of stigma and Gidden's theory of the risk society. The results show that people with GAD live with a constant anxiety that affects their entire life situation, such as their work, leisure, and social relationships. Their anxiety can be likened to an allergy to uncertainty as it´s triggered by something they cannot control. They feel stigmatized by others and feel that they often need to hide their stigma by living behind a facade. To deal with generalized anxiety, three different strategies are used, which are trying to control everything, avoiding anxiety by not exposing oneself to things that cause concern or by keeping oneself busy. However, these strategies can aggravate the condition but there are many things that can relieve general anxiety. The most prominent factors are medicine, therapy, emotional support and self-help such as exercise and meditation. But the results show that the symptoms persist despite great efforts and several treatments, which indicates that more research and more effective interventions are required. The study concludes that GAD is not only a problem that exists within the individual but also in interpersonal relationships and in the society. It also concludes that there must be a change in the structures of society regarding mental illness, and that interventions should not only be directed towards the individual but also towards the relatives. This because the results show that relatives are also affected and that their influence can both aggravate and improve the individual's condition. / Den här studien syftar till att få en ökad förståelse för generaliserat ångestsyndrom utifrån hur målgruppen själva beskriver sina upplevelser. Empirin samlades in genom poddar där personer med GAD berättade om sin livssituation, vilka strategier de använder för att hantera generell ångest och vad de anser lindrar generell ångest. Materialet analyserades genom en tematisk analys där fyra huvudteman togs fram; en konstant oro, hantera stigma, kontrollera eller undvika och endast lindra inte bota. Dessa teman analyserades utifrån Goffmans stigmateori och Giddens risksamhällesteori. Resultatet visar att personer med GAD lever med en konstant oro som påverkar hela deras livssituation, så som deras arbete, fritid och sociala relationer. Deras oro kan liknas med en allergi mot ovisshet då den triggas av sådant de inte kan kontrollera. De upplever sig stigmatiserade av andra och känner att de ofta behöver dölja sitt stigma genom att leva bakom en fasad. För att hantera generaliserad ångest används tre olika strategier vilka är att försöka kontrollera allt eller att undvika ångesten genom att inte utsätta sig för sådant som väcker oro eller att ständigt aktivera sig. Dessa strategier kan dock förvärra tillståndet, men det finns mycket som kan lindra generell ångest. De mest framträdande faktorerna är medicin, terapi, emotionellt stöd och självhjälp, som exempelvis meditation och träning. Resultatet visar dock att symtomen kvarstår trots stora ansträngningar och flertalet behandlingar vilket tyder på att mer forskning och effektivare interventioner krävs. Studien konkluderar att GAD inte enbart är ett problem som existerar inom individen utan även i mellanmänskliga relationer och i samhället som helhet. Därmed dras också slutsatsen att det måste ske en förändring i samhällsstrukturerna avseende psykisk ohälsa och att interventioner inte enbart bör riktas mot individen utan även anhöriga. Detta då resultatet visar att anhöriga också påverkas och att deras inflytande både kan förvärra och förbättra individens tillstånd.

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[pt] Os distúrbios de ansiedade compreendem uma ampla gama de condições psiquiátricas, incluindo transtorno de ansiedade generalizada (TAG) e fobia específica. Nas últimas décadas, o uso de modelos animais de ansiedade ofereceu importantes insights sobre a interação dessas psicopatologias. Aqui nós investigamos se os ratos Cariocas de alto e baixo congelamento (CAC e CBC, respectivamente), um modelo animal de TAG, mostram fenótipos comportamentais de alto e baixo congelamento similar no condicionamento de medo ao som. Ratos adultos das linhagens CAC (n igual 16), CBC (n igual 16) e ratos Wistar normais (controle, CTL) foram testados em um paradigma de condicionamento clássico de medo ao som durante 3 dias. Respostas de congelamento foram medidas e usadas como evidência de condicionamento de medo. No geral, os ratos CAC e CBC, bem como os animais CTL, apresentaram um condicionamento de medo ao estímulo condicionado auditivo. No entanto, os animais CBC também mostraram uma rápida extinção ao estímulo condicionado auditivo. Discutimos esses resultados de acordo com dados comportamentais e neuronais observados em linhagens de roedores de alta e baixa ansiedade. / [en] Anxiety disorders comprise a broad range of psychiatric conditions, including general anxiety (GAD) and specific phobias. For the last decades the use of animal models of anxiety has offered important insights into the understanding of the association between these psychopathologies. Here we investigate whether Carioca high and low conditioned freezing rats (CHF and CLF, respectively), a GAD animal model of anxiety, show similar high and low freezing behavioral phenotypes for cued auditory fear conditioning. Adult CHF (n equal 16), CLF (n equal 16) and normal age-matched Wistar rats (control, CTL) were tested in a classical auditory cued fear conditioning paradigm over 3 days. Freezing responses were measured and used as evidence of fear conditioning. Overall, both CHF and CLF rats as well as CTL animals displayed fear conditioning to the auditory CS. However, CLF animals showed a rapid extinction to the auditory conditioned stimulus compared to CHF and CTL rats. We discuss these findings in the context of the behavioural and neuronal differences observed in rodent lines of high and low anxiety traits.