Worry and Generalized Anxiety Disorder: A Review and Theoretical Synthesis of Evidence on Nature, Etiology, Mechanisms, and Treatment

Abstract

Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.

Central relaxin-3 receptor (RXFP3) activation reduces elevated, but not basal, anxiety-like behaviour in C57BL/6J mice

“…Anxiety disorders comprise a highly prevalent, heterogeneous group of clinically defined psychiatric conditions [1,2], which stem from a wide range of potential causes [3,4], and are often co-morbid with other psychiatric conditions such as addiction or mood disorders [5,6].…”

Emotional intensity reduces later generalized anxiety disorder symptoms when fear of anxiety and negative problem-solving appraisal are low

“…Newman and Llera (2011) found a lack of augmentation of CBT by emotion processing techniques in a randomized controlled trial and questioned the emphasis on interpersonal context and phenomenological experience of current techniques for enhancing emotional processing, further suggesting the need to explore conditions under which emotional processing is successful. Newman and Llera (2011) recommended the more focused use of exposure to sudden increases in emotion, based on their review (Newman, Llera, Erickson, Przeworski, & Castonguay, 2013) and empirical evidence (Llera & Newman, 2014) indicating that worry does not suppress emotions but functions to avoid the impact of a sudden increase in emotions by maintaining a sustained negative emotional state.…”

Impact of personality disorder comorbidity on cognitive-behavioral therapy outcome for mood and anxiety disorders: results from a university training clinic

“…Second, another assumption of personality and psychotherapy has been that personality disorders impair the formation of the therapeutic alliance and/or can lead to ruptures in an otherwise good working alliance (e.g., Martino, Menchetti, Pozzi, & Berardi, 2012;Zinbarg et al 2008). In a recent review of GAD, its etiology, and treatment, Newman, Llera, Erickson, Przeworski, and Castonguay (2013) summarized the predictive validity of interpersonal problems linked to personality traits that can contribute to poorer outcomes in CBT for GAD. We did not routinely measure the therapeutic alliance in our training clinic but we now are recommending the Inventory of Interpersonal Problems (IIP, Horowitz, Alden, Wiggins, & Pincus, 2000) as a supplemental measure (Hawkins & Meier, 2015), which would permit future research studies to explore the contribution of negative personality attributes that may impact the working alliance and thus limit treatment effectiveness for anxious and/or depressed clients with comorbid personality disorders.…”