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].…”

Conditioned Fear Acquisition and Generalization in Generalized Anxiety Disorder

“…Although fear conditioning processes do not feature prominently among current theoretical explanations of GAD (see Behar, DiMarco, Hekler, Mohlman, & Staples 2009;Newman, Llera, Erickson, Przeworski, & Castonguay, 2013), some typical GAD characteristics such as the tendency to interpret ambiguous stimuli as threatening (see Lissek et al, 2013) suggest that these processes may have an important role in the disorder and that more studies in the field are needed. In the present study, we examined conditioned fear-acquisition and fear-generalization in GAD patients using a fear conditioning paradigm assessing fear-potentiated startle (FPS) and subjective responses.…”

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.…”