Research Project Update

Hello again!

The past two weeks have seen me do a bit more research into what Generalised Anxiety Disorder is, it's symptoms and current treatments. What I have uncovered is both surprising and not so surprising in other areas. What did surprise me was the sheer amount of symptoms that can contribute to the illness and how common it actually is. What didn't surprise me was the lack of services available and the go to mentality in regards to drug therapy. This lack of available services got me thinking, what can we do as game designers to help alleviate the strain on doctors and therapists? I have also begun touching on research in regards to how games and Virtual Reality are being used to treat anxiety disorders and what I've uncovered is quite interesting. All of the research I have conducted so far has led me to believe even more fervently that we as game designers can do a lot when it comes to helping others. Here's a very rough thousand or so words of my research into the topic of GAD (you'll have to excuse the incorrect citations, these will be addressed in the final copy):

Generalised Anxiety Disorder

To begin one must define the subject they are talking about: Generalised Anxiety Disorder or GAD is mental illness that has been around for a while now and has undergone several refinements in order for someone to be diagnosed with it. Tyrer and Baldwin define GAD as: “a persistent and common disorder, in which the patient has unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations”(2006, p.2156). This definition in itself is quite ambiguous and hard to pinpoint a solid cause or definition with any accuracy what exactly the disorder is. Perhaps the above definition should be introduced in more laymans terms: someone who has a worry or anxiety towards a situation, event or thing that would not be considered normal likely suffers from GAD. However, in saying that GAD is a very difficult to diagnose disorder: how do we know if a patient is simply overthinking a situation or responding unreasonably to an event? If the definition of GAD is so ambiguous, how can we even move to treat the disorder? This section of the project will answer those questions. Furthermore, a detailed explanation of the ilness will help us to understand the process and influence further aspects of this project.

To diagnose GAD a patient must be suffering from several of a list of symptoms for a specific period of time. There are several main symptoms by which one can be diagnosed with GAD, of which the most common include: palpitations, excessive worry over minor day to day problems, obvious tension, dry mouth, sweating breathing difficulties, chest pain, feeling of choking, nausea, trembling, fear of not having/losing control, restlessness and inability to sleep easily (Tyrer & Bladwin, 2006, p.2157). As evident there are quite a few symptoms from which a patient can suffer in order to be diagnosed with GAD. These symptoms tend to be brought on when the patient in question is directly confronted by the object, thing or environment that causes the anxiety. However while this is the most common cause, simply thinking about the situation can bring on the anxiety as well as the hippocampus (the part of our brain that is responsible for memory) has been associated with GAD (Tyrer & Bladwin, 2006, p.2158). The nature of GAD makes it a complex and difficult illness to treat: the brain itself is a complex organ and when something goes wrong with it, it takes a while to figure out how to correct it, restore it to normal. Most often than not this a laborious and time consuming process which is highly demanding of commitment on the patients’ part.

Treating GAD itself took a while to figure out and it has undergone many changes over the years since its inception. In the past, medical practitioners have defined GAD as: 

“the presence of generalized, persistent anxiety (continuous for a period of at least 1 month) as manifested by symptoms from at least three of four categories: (1) motor tension (e.g., muscle aches, restlessness); (2) autonomic hyperactivity (e.g., sweating, dizziness, accelerated heart rate); (3) apprehensive expectation (e.g., anxiety, worry, fear); and (4) vigilance and scanning (e.g., concentration difficulties, irritability)” (Barlow, Brown and O’Learyp.155).” 

However, Barlow, Brown and O’leary further elaborate that because people were experiencing symptoms that didn’t relate to the other disorders, it was decided that the criteria for GAD had to be expanded. This change included a change for consistent symptoms to be present for 6 months rather than one, the criteria for diagnosis had to have two or more unrealistic worries and be unrelated to another disorder, and patients had to exhibit at least 6 symptoms from a list of eighteen (p.155).

Although someone may be diagnosed, getting treatment is another matter entirely. There is a lack of time and services available to treat those who suffer from GAD often leading to treatments using “what is available, rather than what is best” (Tyrer & Baldwin, 2006, p.2159) with therapy being the main form of treatment. “Doctors in most western countries will probably prescribe drug treatment most commonly, irrespective of patient choice” (Tyrer & Baldwin, 2006, p.2159). The efficacy of these drugs are not disputed, they are very effective controlling the symptoms for GAD when a patient encounters situations where they would exhibit symptoms, what is of concern is the side effects some of these drugs can have: most often patients become dependent on the drug just to function in everyday life and once removed, the risk of relapse is high. Other long term effects that have been recorded cannot only lead to dependency, but patients can suffer symptoms of withdrawal and some, addiction.

Nowadays, GAD is most often treated with either drugs, behavioural therapy or some combination of both. There have been many studies in which both methods have proved effective in the treatment of GAD and some that prove a combination of both to the best. However, it can be difficult to get patients to commit to both as they likely exhibit since of aversion to one form of treatment over the other (Tyrer & Baldwin, 2006, p.2163). This introduces another obstacle for the Doctor to help the patient overcome; not only has the patient likely suffered for many years from GAD, they are often their own enemy when it comes to treatment. Barlow, Brown and O’Leary state that “Patients with GAD often present with a life-long history of generalized anxiety. For example, several studies have found that a large proportion of patient with GAD cannot report a clear age of onset or report an onset dating back to childhood” (p.156) This often means that the illness can become very difficult to treat and break, often taking years of hard work on the part of the patient to overcome.

There are several techniques that can be employed to help manage the symptoms of GAD, therapies such as Cognitive Behavioural and Relaxation Therapies have proved extremely effective in relieving GAD symptoms as reinforced by Tyrer and & Baldwin (2006): “A systematic review of complementary therapies showed . . . evidence for use of relaxation training, exercise, and kava in generalised anxiety disorder” (p.2162). Relaxing acts such as simply inhaling deeply, immersing oneself in calming sounds or closing one’s eyes and tuning out the situation for a while all help the patient recover their composure and defeat their anxiety in the moment. Other, more long-term practices such as therapy sessions with a therapist to change how the patient sees themselves and the situation have also proved very effective. 

Having perused several articles and journals concerning the treatment of GAD, I have come to the conclusion that both cognitive behavioural therapy in combination with relaxation techniques are the most effective forms of managing and treating GAD. Several sources reinforce this: “these cognitive and somatic features have been most frequently addressed with cognitive therapy and some form of relaxation treatment, respectively” (p.160, barlow, brown, o’leary), and in relation to combined treatments “A review of  14  studies  of  psychological  treatment  in  generalised     anxiety     disorder     revealed     modest     improvements  in  symptoms,  with  50%  of  patients  achieving  relief  of  somatic  symptoms  and  a  similar  proportion attaining normal function after treatment (p.2161, Tyrer, Baldwin). How we as game designers can contribute to recovery of sufferers of GAD has already begun to be explored.

I hope this information both helps you understand a little more about GAD and shows what I am focusing on. there is a lot more that I can talk about and what I really want to delve a bit more into is how the specific symptoms can be alleviated. Once I have discovered that I can begin creating my game.

Ciao!