A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry

Abstract

An important emphasis of the literature on generalized anxiety disorder (GAD) has been to achieve a greater understanding of the function of emotion (e.g., avoidance, dysregulation) in the etiology and maintenance of this disorder. The purpose of the following paper is to propose a new way of conceptualizing emotional sequelae in GAD by detailing the Contrast Avoidance Model of Worry. In presenting this model, we review theory and data that led to our current position, which is that individuals with GAD are more sensitive to feeling emotionally vulnerable to unexpected negative events, and that worry (the key pathological feature of GAD) is employed to prolong and maintain a negative emotional state thereby avoiding an unexpected negative emotional shift, or contrast experience. We also discuss implications for treatment given the presence of a new target for emotional exposure techniques. Finally, we establish the Contrast Avoidance Model within the framework of extant theories and models of pathogenic processes of GAD.

Metacognitive, Emotional, and Avoidance Predictors of Generalized Anxiety Disorder

“…Fourth, future studies should examine how fear of emotions leads to GAD psychopathology. Newman (2014) andLlera (2011) proposed that worry does not suppress emotional arousal, but rather enables individuals to avoid the experience of unexpected worsening of emotions by prolonging negative emotions. This model suggests reasons why people fearful of emotions may worry, and warrants further investigation.…”

Neural markers of positive reappraisal and their associations with trait reappraisal and worry.

“…Worry has been conceptualized not only as the cognitive component of anxiety but also as a maladaptive emotion regulation strategy in that it is concerned with generating ways in which one might deal with or prevent negative future events and experiences (Borkovec, 1994;Borkovec, Alcaine, & Behar, 2004;Mennin, Heimberg, Turk, & Fresco, 2005;Newman & Llera, 2011). Unfortunately, solutions are rarely reached in chronic worries using this so-called "what-if" process of unproductive repetitive thought, but it continues nonetheless (Watkins, 2008).…”

“…Unfortunately, solutions are rarely reached in chronic worries using this so-called "what-if" process of unproductive repetitive thought, but it continues nonetheless (Watkins, 2008). By negatively reappraising experiences in ways that catastrophize outcomes (Newman & Llera, 2011), chronic worriers, and those diagnosed with GAD, report engaging in reappraisal less often (Aldao & Mennin, 2012;Zlomke & Hahn, 2010).…”

The relationship between low levels of mindfulness skills and pathological worry: The mediating role of psychological inflexibility. [La relación entre habilidades de mindfulness y preocupación patológica: El rol mediador de la inflexibilidad psicológica]

“…However, excessive worry can also be a source of distress and is pervasive across anxiety and depressive disorders (e.g., Olatunji, Wolitzky-Taylor, Sawchuk, & Ciesielski, 2010). More specifically, maladaptive worry is the central feature of generalized anxiety disorder (GAD), with research strongly supporting the notion that it serves as an avoidant strategy in response to perceived future threats (e.g., Borkovec, 1994;Borkovec, Alcaine, & Behar, 2004;Newman & Llera, 2011;Roemer & Orsillo, 2002). GAD tends to be a chronic disorder leading to significant functional impairment, associated with high rates of comorbidity (e.g., Brown, Campbell, Lehman, Grisham, & Mancill, 2001;Kessler, Waters, & Wittchen, 2004), anales de psicología, 2014, vol.…”