Worry and generalized anxiety disorder: A review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment

Michelle G. Newman, Sandra J. Llera, Thane M. Erickson, Amy Przeworski, Louis G. Castonguay

Research output: Contribution to journalReview article

129 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)275-297
Number of pages23
JournalAnnual Review of Clinical Psychology
Volume9
DOIs
StatePublished - Mar 2013

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health

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