The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder

The role of worry in generalized anxiety disorder (GAD) has been posited to serve as an avoidance of emotional experience, and emotion regulation deficits in GAD have been found in several previous studies. It remains unclear whether those with GAD experience more dysregulated emotions during periods of euthymia and positive affect or whether these deficits occur only during periods of worry. Individuals with GAD (with and without co-occurring dysphoria) and non-anxious controls were randomly assigned to receive a worry, neutral, or relaxation induction. Following the induction, all participants viewed a film clip documented to elicit sadness. Intensity of emotions and emotion regulation were examined following the induction period and film clip. The results revealed that, regardless of co-occurring dysphoria, individuals with GAD in the worry condition experienced more intense depressed affect than GAD participants in the other conditions and controls participants. In contrast, presence of worry appeared to have less impact on indices of emotion dysregulation, which were greater in participants with GAD compared to controls, but largely insensitive to contextual effects of worry or of relaxation. Following film viewing, both GAD participants with and without dysphoria displayed poorer understanding, acceptance, and management of emotions than did controls. However, acceptance and management deficits were most pronounced in individuals with both GAD and co-occurring dysphoria. Implications for the role of emotions in conceptualization and treatment of GAD are discussed.     

The impact of pretrauma analogue GAD and posttraumatic emotional reactivity following exposure to the September 11 terrorist attacks: a longitudinal study

The relation between analogue generalized anxiety disorder (GAD) assessed the day before the events of September 11, 2001 (9/11) and long-term outcome was examined in 44 young adults who were directly exposed the following day to the terrorist attacks in New York City. After controlling for high exposure to the attacks, preattack analogue GAD was associated with greater social and work disability, loss of psychosocial resources, anxiety and mood symptoms, and worry, but not symptoms of posttraumatic stress, assessed 12 months after 9/11. Fear and avoidance of emotions assessed 4 months after 9/11 statistically mediated the relation between preattack analogue GAD and social and work disability, loss of psychosocial support, mood and anxiety symptoms, and worry at 12-month follow-up. Avoidance of emotions 4 months after 9/11 also mediated the relation between preattack analogue GAD and posttraumatic stress symptoms 12 months after 9/11.     

Utilizing an Ability-Based Measure to Detect Emotion Regulation Deficits in Generalized Anxiety Disorder

In recent years, the field of emotion regulation has advanced current conceptualizations of many forms of psychopathology. Difficulties with emotion regulation have been detected via self-report in several anxiety and depressive disorders, and in particular, generalized anxiety disorder (GAD). However, there is a paucity of research examining emotion regulation ability in this population, leaving open the possibility that self-report measures reflect an individual’s perception of his/her emotion regulation skills rather than skills themselves. The present study examined the utility of an ability-based measure of emotional intelligence in the assessment of emotion-related deficits in GAD as well as the concordance between the ability-based measure and self-reports of emotion regulation skills. Results revealed that individuals with GAD demonstrated significantly more difficulty regulating their emotions than control participants did on both ability-based and self-report measures. Further, these measures showed a moderate concordance with each other. Findings suggest it will be important to integrate ability-based measurement of emotion-related deficits with other assessment modalities.     

Effects of induced and naturalistic mood on the temporal allocation of attention to emotional information

Building upon recent findings that affective states can influence the allocation of spatial attention, we investigate how state, trait and induced mood are related to the temporal allocation of attention to emotional information. In the present study, 125 unscreened undergraduates completed a modified rapid serial visual presentation task designed to assess the time course of attention to positive and negative information, comparing a neutral baseline mood induction to either a positive or negative mood induction. Induced negative mood facilitated attentional engagement to positive information while decreasing attentional engagement to negative information. Greater naturally occurring negative state mood was associated with faster or more efficient disengagement of attention from negative information in the presence of manipulated negative mood, relative to baseline. The engagement findings were inconsistent with our mood-congruence hypotheses and may be better explained by mood repair or affective counter-regulation theories. In contrast, the disengagement findings for state mood were somewhat consistent with our mood-congruence hypotheses. The relationship between mood and attention to emotional information may differ depending on the combination of attentional mechanism (engagement versus disengagement), aspect of mood (state, trait or induced), stimulus valence (positive versus negative) and timescale (early versus late) under investigation.     

Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: Further evaluation

Despite its acute efficacy for the treatment of panic disorder, benzodiazepines (BZs) are associated with a withdrawal syndrome that closely mimics anxiety sensations, leading to difficulty with treatment discontinuation and often disorder relapse. An exposure-based cognitive-behavioral treatment for BZ discontinuation, Panic Control Treatment for BZ Discontinuation (CBT) targets the fear of these sensations and has demonstrated efficacy in preventing disorder relapse and facilitating successful BZ discontinuation among patients with panic disorder. In this randomized controlled trial, CBT was compared to taper alone and a taper plus a relaxation condition to control for the effect of therapist contact and support among 47 patients with panic disorder seeking taper from BZs. Based on the primary outcome of successful discontinuation of BZ use, results indicate that adjunctive CBT provided additive benefits above both taper alone and taper plus relaxation, with consistently medium and large effect sizes over time that reached significance at the six month follow-up evaluation. The efficacy of CBT relative to either of the other taper conditions reflected very large and significant effect sizes at that time. These findings suggest that CBT provides specific efficacy for the successful discontinuation from BZs, even when controlling for therapist contact and relaxation training.