A comprehensive and authoritative guide to anxiety disorder and worry
Generalized Anxiety Disorder offers a comprehensive review of the most current research and therapeutic modalities related to generalized anxiety disorder and worry (GAD). With contributions from an international panel of experts, the Handbook links the basic science of anxiety and worry to the effective treatments that can be applied to help those who suffer from these conditions.
Reflecting the most recent research and developments on the topic, the Handbook contains information on cross-cultural issues, transdiagnostic questions, as well as material on learning theory, biological theory, psychotherapy, and psychopharmacology. The contributors offer an in-depth examination of a range of topics such as rumination and obsessions and contains several novel approaches to treating the disorder. This comprehensive resource:
- Contains the most current information available on the topic
- Explores the consequences of worrying and other mental disorders such as illness anxiety and sleep disorders
- Includes contributions from an international panel of experts
- Offers insight into the future of treatment outcomes and translational research
Written for practitioners, researchers, and trainees of clinical psychology and psychiatry, Generalized Anxiety Disorder addresses the assessment and empirically supported treatment of generalized anxiety disorder.
1 Worry, GAD, & their importance
1.1 What is Worry – What is GAD? Epidemiology
1.2 Where do GAD patients present and what cost for the health system?
1.3 Introduction and Overview of the Handbook
2 Assessing Worry: An Overview
2.2 What is worrying?
2.3 Assessments of GAD and worry
2.3.1 Challenges in assessing GAD and worry
2.3.2 Assessing worry and GAD with the event sampling methodology
2.4 Differential diagnosis of GAD and the overlap of worry with related constructs
3 Perceptions of Threat
3.2 Measuring perceptions of threat
3.3 Research linking perceptions of threat and worrying
3.4 Formation of threat perception: potential antecedents
3.4.1 Negative beliefs.
3.4.2 Intolerance of uncertainty.
3.4.3 High performance standards.
3.4.4 Goal investment
3.5 Moderators of the relationship between perceived threat and worry
3.6 Potential Clinical Implications
3.7 Future Directions for Research
4 Transdiagnostic View on Worrying and Other Negative Mental Content
4.2 Is Worry a Transdiagnostic Process?
4.3 Is Worry Just a Variant of Transdiagnostic RNT?
4.3.1 Definition of Repetitive Negative Thinking (RNT)
4.3.2 Evidence for the Construct of RNT
4.3.3 Looking Beyond Worry and Rumination
4.3.4 Assessment of RNT from a Transdiagnostic Perspective
4.4 Theoretical Models of RNT as a Transdiagnostic Process
4.4.1 Emotional Avoidance Models
4.4.2 Emotion Dysregulation Models
4.4.3 Meta-Cognitive Model
4.4.4 Information Processing and Cognitive Control Models
4.4.5 An Integrative Model of Transdiagnostic RNT
188.8.131.52 RNT as an Adaptive Process
184.108.40.206 RNT as a Maladaptive Process
4.5 Treatment of Worry/RNT from a Transdiagnostic Perspective
4.5.1 Which Interventions are Efficacious to Reduce RNT?
4.5.2 Where to Go From Here?
4.6 Conclusions and Future Direction
5 Worry and other mental health problems
5.2 Health anxiety
5.2.1 Health anxiety: Definition, diagnosis, and prevalence
220.127.116.11 Research findings on worry in health anxiety: Cross-sectional findings
18.104.22.168 Research findings on worry in health anxiety: Longitudinal findings
22.214.171.124 Research findings on worry in health anxiety: Findings from treatment studies
5.2.3 Worry and health anxiety: Concluding remarks
5.3 Worry and insomnia disorder
5.3.1 Insomnia disorder: Definition, diagnosis, and prevalence
126.96.36.199 Research findings on worry in insomnia disorder: Cross-sectional findings
188.8.131.52 Research findings on worry in insomnia disorder: Longitudinal findings
184.108.40.206 Research findings on worry in insomnia disorder: Findings from treatment studies
5.3.3 Worry and insomnia disorder: Concluding remarks
5.4 Concluding Remarks and Future Directions
6 Learning Science and Generalized Anxiety Disorder (GAD)
6.2 Basic conditioning theory and avoidance learning
6.3 Excitatory fear mechanisms and fear generalization in GAD
6.4 Borkovec’s Avoidance Model
6.5 Relational Frame Theory and GAD
6.6 AARR and Generalized Anxiety Disorder
7 Cognitive Behavioural Models of Generalized Anxiety Disorder: Toward a Synthesis
7.2 Historical Underpinnings of Cognitive-Behavioural Conceptualizations of GAD
7.3 Distal Theories of GAD
7.3.1 The Cognitive Avoidance Model
7.3.2 Metacognitive Theory
7.3.3 Intolerance of Uncertainty Model
7.3.4 Acceptance-Based Model
7.3.5 Emotion Dysregulation Model
7.3.6 Contrast Avoidance Model
7.4 Proximal Theories Explaining the Process of Worrying
7.4.1 Mood As Input Hypothesis
7.4.2 The Cognitive Model of Pathological Worry
7.5 Cognitive-Behavioural Models of GAD: Synthesis and Discussion
7.5.1 Distal Theories
7.5.2 Proximal Theories
8 Structural and functional neuroanatomy of generalized anxiety disorder
8.2 Brain functions related to fear and anxiety
8.3 Brain structure and function in GAD
8.3.1 Assessment of brain structure and function
220.127.116.11 Assessment of brain structure
18.104.22.168 Assessment of brain function
8.3.2 Brain structure in GAD
22.214.171.124 White matter volume and structural connectivity
8.3.3 Brain function in GAD
126.96.36.199 Children and adolescents
188.8.131.52 Functional connectivity
184.108.40.206 Treatment studies
8.4 Integration of findings and outlook
9 Cultural Perspectives in Understanding, Treating, and Studying Worry and Generalized Anxiety Disorder
9.2 Culture and Psychopathology
9.3 Cultural Conceptualizations of GAD
9.3.1 The Unidimensional Model of a Cultural Conceptualization of GAD
9.3.2 The Bidimensional Model of Cultural Conceptualization of GAD
9.4 Cultural Influences on Worry and GAD
9.4.1 Racial and Ethnic Differences
220.127.116.11 Prevalence of GAD
18.104.22.168 Contents and structure of worry.
22.214.171.124 Manifestation of worry.
9.4.2 Social and Contextual Factors, Gender, and Age
9.4.3 Acculturation and GAD
9.5 General Considerations on Becoming Culturally Competent Therapists
9.5.1 A tripartite Model of Multicultural Competence
126.96.36.199 Culturally Sensitive Attitudes and Beliefs
188.8.131.52 Cultural Knowledge
184.108.40.206 Culturally Competent Skills
9.5.2 Cultural Formulation Interview: Diagnosing GAD from a Cultural Perspective
220.127.116.11 Cultural definition of the problem.
18.104.22.168 Cultural perceptions of cause, context, and support
22.214.171.124 Cultural factors affecting coping and help-seeking.
9.5.3 Cultural Considerations in Diagnosing GAD
126.96.36.199 Category Fallacy
188.8.131.52 A Cultural Dissection of DSM-5 GAD Criteria
184.108.40.206 Other Diagnostic Instruments of GAD
9.5.4 Culturally Adapted Treatments of GAD
220.127.116.11 Culture Adapted Psychopharmacological Treatment.
18.104.22.168 Culturally Adapted Cognitive-Behavioral Therapies
22.214.171.124 Culture-Specific Resources and Healing Practices as Adjunct Treatments
9.6 Considerations and Directions for Research on Culture and GAD
9.6.1 Establish Measurement Equivalence
9.6.2 Increase Use of Longitudinal Data and Structure-Oriented Comparisons
10 Cognitive Behavioral Therapy (CBT) for Generalized Anxiety Disorder (GAD)
10.2 Implementation of CBT for GAD
10.2.2 Relaxation Training.
10.2.3 Progressive Muscle Relaxation (PMR).
10.2.4 Imagery Training.
10.2.6 Applied Relaxation.
10.2.7 Self-Control Desensitization (SCD).
10.2.8 Stimulus Control.
10.2.9 Worry exposure.
10.2.10 Cognitive Restructuring
10.3 Systematic treatment conceptualizations for GAD
10.3.1 Metacognitive therapy.
10.3.2 Intolerance-of-uncertainty therapy.
10.3.3 Emotion-regulation therapy.
10.3.4 Predictors of Treatment Outcome of CBT for GAD
10.4 Psychotherapy for GAD: Variations and communalities
11 Interpersonal and Emotion-focused Therapy (I/EP) for Generalized Anxiety Disorder
11.2 Overview, Process, and Implementation of Interpersonal Therapy/ Emotional Therapy
11.2.1 Processing Therapy (I/EP).
11.2.2 Social skills training.
11.2.3 Use of therapist-client interaction as treatment tool.
11.2.4 Emotional Processing aspects of I/EP.
11.3 Future Directions of I/EP
12 Acceptance-based behavioral therapies for GAD
12.2 An acceptance-based behavioral model of GAD
12.2.1 Problematic relationship to internal experiences
12.2.2 Rigid experiential avoidance
12.2.3 Restrictions (behaviorally and/or attentionally) in engaging in meaningful actions
12.3 Acceptance-based Behavioral Therapy for GAD
12.3.1 Assessment of ABBT components
12.3.2 Development of the therapeutic relationship
12.3.3 Psychoeducation to cultivate awareness/acceptance
126.96.36.199 An acceptance-based behavioral model of fear and anxiety
188.8.131.52 Understanding worry.
184.108.40.206 Clear and muddy emotions.
220.127.116.11 Paradoxical effects of control.
12.3.4 Developing habits of awareness/acceptance
18.104.22.168 Monitoring/noticing early cues.
22.214.171.124 Formal mindfulness practices
126.96.36.199 Informal mindfulness.
12.3.5 Clarifying what matters
188.8.131.52 Goal/rigidly defined by one behavior.
184.108.40.206 Desire to control the uncontrollable.
220.127.116.11 Desire to be perfect.
12.3.6 Putting it all together – doing what matters
18.104.22.168 Clarifying emotions.
22.214.171.124 Choosing actions
126.96.36.199 Addressing barriers
12.3.7 Efficacy and effectiveness of ABBT approaches
12.4 Future directions
13 Short-term psychodynamic therapy of generalized anxiety disorder
13.2 A psychodynamic model of GAD
13.3 Short-term psychodynamic therapy for GAD
13.3.1 Module 1: Informing the patient about GAD and its treatment: the socialization interview
13.3.2 Module 2: Motivating, addressing ambivalence and setting treatment goals
13.3.3 Module 3: Supportive Interventions and establishing a secure therapeutic alliance
13.3.4 Module 4: Identifying and focusing on the CCRT underlying the GAD symptoms
188.8.131.52 Module 4.1: Focusing on the warded-off affect – experiencing the wish component (W) of the CCRT
184.108.40.206 Module 4.2: The RO component of the CCRT – modifying underlying internalized object relations
220.127.116.11 Module 4.3: Changing the RS component: encouraging the patient to confront the feared situation and to give up avoidance
18.104.22.168 Module 4.4: Fostering more adaptive internal responses of the self (RS): the internalized encouraging dialogue
13.3.5 Module 5: Addressing (potential) non-response and resistance
13.3.6 Module 6: Termination and Relapse Prevention
13.3.7 Phases of treatment
13.4 Phases of treatment
13.4.1 Diagnostic assessments, informing the patient and making treatment arrangements (introductory sessions)
13.4.2 Early phase
13.4.3 Middle phase
13.4.4. Termination phase (treatment sessions 17-22)
13.4.5 Booster sessions
14 Pharmacological treatment of generalized anxiety disorder
14.2 Initial treatment
14.3 Continuation treatment
14.4 The contentious place of benzodiazepines
14.5 The place of pregabalin
14.6 Tolerability concerns
14.7 Further management after non-response to initial treatment approaches
14.8 Stopping treatment
14.9 Potential novel targets for pharmacological treatment
15 Internet- and computer-based treatments of GAD
15.2 Internet-supported psychological treatment
15.2.1 Effects of internet-supported psychological treatments for GAD
15.3 Cognitive Bias Modification
15.3.1 Effects of CBM for GAD
15.4 Discussion and future directions
16 GAD in children and adolescents
16.4.1 The evidence base for the treatment of (any) childhood anxiety disorders
16.4.2 The evidence base for the treatment of childhood GAD
16.5. Psychotherapy for childhood GAD
16.6. Case example of a treatment based on the Laval model of GAD
16.6.1 Treatment components
16.6.2 Developmental considerations
16.7. The case of Sara
16.7.2 Course of treatment
16.7.3 Worry awareness training and socialization to the treatment model
16.7.4 Problems versus worries
16.7.5 Targeting intolerance of uncertainty
16.7.6 Worry behaviors
16.7.7 Identifying Sara’s treatment goals
16.7.8 Behavioral experiments
16.7.9 Problem solving
16.7.10 Cognitive avoidance and imaginal exposure
16.7.11 Termination and relapse prevention
16.8. Additional exercises for children with GAD
17 The road ahead: what research paths should be taken in order to improve future treatments?
17.1. Nosological Considerations: Diagnostic Overlap?
17.2. GAD in the days of R-DoC and Network Analysis
17.3. What can diagnostic-specific information add?
17.4. What context variables impact treatment?
17.5. The path forward