Skip to main content
SpringerLink
Log in

Fear and Avoidance of Internal Experiences in GAD: Preliminary Tests of a Conceptual Model

  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

The tendency to fear and avoid internal experiences may be an important characteristic of individuals with generalized anxiety disorder (GAD). We review here theory and research suggesting that individuals with GAD may be experientially avoidant, and present preliminary evidence to support this model. Findings from both a non-clinical and clinical sample suggest that worry and generalized anxiety disorder may be associated with a tendency to try to avoid or control (versus accept) internal experiences, as well as a tendency to fear losing control over one’s own emotional responses (particularly anxiety). The clinical implications of these findings, along with directions for future research, are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abel, J. L., & Borkovec, T. D. (1995). Generalizability of DSM-III-R generalized anxiety disorders to proposed DSM-IV criteria and cross-validation of proposed changes. Journal of Anxiety Disorders, 9, 303–315.

    Google Scholar 

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

  • Andrews, V. H., & Borkovec, T. D. (1988). The differential effects of inductions of worry, somatic anxiety, and depression on emotional experience. Journal of Behavior Therapy and Experimental Psychiatry, 19, 21–26.

    Google Scholar 

  • Berg, C. Z., Shapiro, N., Chambless, D. L., & Ahrens, A. H. (1998). Are emotions frightening? II: An analogue study of fear of emotion, interpersonal conflict, and panic onset. Behaviour Research and Therapy, 36, 3–15.

    Google Scholar 

  • Borkovec, T. D. (1994) The nature, functions, and origins of worry. In G. C. L. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment, and treatment (pp. 5–34). New York: Wiley.

    Google Scholar 

  • Borkovec, T. D. (1999). The nature and psychosocial treatment of generalized anxiety disorder. Paper presented at the annual meeting of the American Psychological Society, Denver, CO.

  • Borkovec, T. D. (2002). Life in the future versus life in the present. Clinical Psychology: Science and Practice, 9, 76–80.

    Google Scholar 

  • Borkovec, T. D., Alcaine, O., & Behar, E. (in press). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice. New York: Guilford Press.

  • Borkovec, T. D., Hazlett-Stevens, H., & Diaz, M. L. (1999). The role of positive beliefs about worry in generalized anxiety disorder and its treatment. Clinical Psychology and Psychotherapy, 6, 126-138.

    Google Scholar 

  • Borkovec, T. D., & Hu, S. (1990). The effect of worry on cardiovascular response to phobic imagery. Behaviour Research and Therapy, 28, 69–73.

    Google Scholar 

  • Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy, 28, 153–158.

    Google Scholar 

  • Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 25–30.

    Google Scholar 

  • Brown, T. A., DiNardo, P. A., Lehman, C. L., & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110, 49–58.

    Google Scholar 

  • Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.

    Google Scholar 

  • Bouton, M. E., Mineka, S., & Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review, 108, 4–32.

    Google Scholar 

  • Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279–296.

    Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum.

    Google Scholar 

  • Cohen, J., & Cohen, P. (1975). Applied multiple regression/correlation analysis for the behavioral sciences. Potomac, Maryland: Lawrence Erlbaum.

    Google Scholar 

  • Connor, K. M., & Davidson, J. R. T. (1998). Generalized anxiety disorder: Neurobiological and pharmacotherapeutic perspectives. Biological Psychiatry, 44, 1286–1294.

    Google Scholar 

  • Craske, M. G., & Hazlett-Steven, H. (2002). Facilitating symptom reduction and behavior change in GAD: The issue of control. Clinical Psychology: Science and Practice, 9, 69–75.

    Google Scholar 

  • Craske, M. G., Rapee, R. M., Jackel, L., & Barlow, D. H. (1989). Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls. Behaviour Research and Therapy, 27, 397–402.

    Google Scholar 

  • DiNardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.

    Google Scholar 

  • Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802.

    Google Scholar 

  • Goldstein, A. J., & Chambless, D. L. (1978). A reanalysis of agoraphobia. Behavior Therapy, 9, 47–59.

    Google Scholar 

  • Greenberg, L. S., & Safran, J. D. (1987). Emotions in psychotherapy. New York: Guilford.

    Google Scholar 

  • Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (in press). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record.

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.

    Google Scholar 

  • Hayes, S. C., Wilson, K. G., Gifford, E. V, Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.

    Google Scholar 

  • Hoehn-Saric, R., & McLeod, D. R. (1988). The peripheral sympathetic nervous system: Its role in normal and pathological anxiety. Psychiatric Clinics of North America, 11, 375–386.

    Google Scholar 

  • Lang, P. J. (1985). The cognitive psychophysiology of emotion: Fear and anxiety. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • LeDoux, J. E. (1996). The emotion brain: The mysterious underpinnings of emotional life. New York: Simon & Schuster.

    Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F., (1995). Manual for the Depression Anxiety Stress Scales. Sydney: The Psychology Foundation of Australia.

    Google Scholar 

  • Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90.

    Google Scholar 

  • Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.

    Google Scholar 

  • Molina, S., & Borkovec, T. D. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In G. C. L. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment, and treatment (pp. 265–283). New York: Wiley.

    Google Scholar 

  • Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T. & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215–233.

    Google Scholar 

  • Orsillo, S. M., & Batten, S. V. (2002). ACT as treatment of a disorder of excessive control: Anorexia. Cognitive and Behavioral Practice, 9, 253–259.

    Google Scholar 

  • Orsillo, S. M., & Batten, S. V. (2004). ACT in the treatment of PTSD. Behavior Modification (pp. 77–108).

  • Purdon, C. (1999). Thought suppression and psychopathology. Behaviour Research and Therapy, 37, 1029–1054.

    Google Scholar 

  • Reiss, S. (1991). Expectancy theory of fear, anxiety, and panic. Clinical Psychology Review, 11, 141-153.

    Google Scholar 

  • Reiss, S., & McNally, R. (1985). The expectancy model of fear. In S. Reiss & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107–121). New York: Academic Press.

    Google Scholar 

  • Roemer, L., Borkovec, M., Posa, S., & Borkovec, T. D. (1995). A self-report measure of generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 26, 345–350.

    Google Scholar 

  • Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9, 54–68.

    Google Scholar 

  • Roemer, L., & Salters, K. (2004). A preliminary study of the effects of directed suppression of rape-related material among rape survivors using unobtrusive measures. Behavioural and Cognitive Psychotherapy, 32, 149–164.

    Google Scholar 

  • Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston: Houghton Mifflin Company.

    Google Scholar 

  • Taylor, S. (1995). Anxiety sensitivity: Theoretical perspectives and recent findings. Behaviour Research and Therapy, 33, 243–258.

    Google Scholar 

  • Taylor, S., Koch, W. J., & McNally, R. J. (1992). How does anxiety sensitivity vary across the anxiety disorders? Journal of Anxiety Disorders, 6, 249–259.

    Google Scholar 

  • Thayer, J. F., Friedman, B. H., Borkovec, T. D., Molina, S., & Johnsen, B. H. (2000). Phasic heart period reactions to cued threat and non-threat stimuli in generalized anxiety disorder. Psychophysiology, 37, 361–368

    Google Scholar 

  • Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 34–52.

    Google Scholar 

  • Wells, A. (2002). GAD, metacognition, and mindfulness: An information processing analysis. Clinical Psychology: Science and Practice, 9, 95–100.

    Google Scholar 

  • Wells, A., & Carter, K. (2001). Further tests of a cognitive model of GAD: Metacognitions and worry in GAD, panic disorder, depression, and nonpatients. Behavior Therapy, 32, 85–102.

    Google Scholar 

  • Wells, A., & Papageorgio, C. (1995). Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy, 33, 579–583.

    Google Scholar 

  • Williams, K. E., Chambless, D. L., & Ahrens, A. (1997). Are emotions frightening? An extension of the fear of fear construct. Behaviour Research and Therapy, 35, 239–248.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of Massachusetts at Boston, 100 Morrissey Boulevard, Boston, Massachusetts

    Lizabeth Roemer PhD & Kristalyn Salters

  2. Boston University, Boston

    Susan D. Raffa

  3. Boston VA Healthcare System and Boston University Medical School, Boston, VA

    Susan M. Orsillo

  4. Department of Psychology, University of Massachusetts at Boston, 100 Morrissey Boulevard, 02125, Boston, Massachusetts

    Lizabeth Roemer PhD

Authors
  1. Lizabeth Roemer PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristalyn Salters
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan D. Raffa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan M. Orsillo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lizabeth Roemer PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roemer, L., Salters, K., Raffa, S.D. et al. Fear and Avoidance of Internal Experiences in GAD: Preliminary Tests of a Conceptual Model. Cogn Ther Res 29, 71–88 (2005). https://doi.org/10.1007/s10608-005-1650-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-005-1650-2

Key words

Search

Navigation