Cognitive Therapy and Research

, Volume 29, Issue 1, pp 71–88 | Cite as

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

  • Lizabeth RoemerEmail author
  • Kristalyn Salters
  • Susan D. Raffa
  • Susan M. Orsillo


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.

Key words

experiential avoidance worry emotion generalized anxiety disorder 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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
  2. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  3. 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
  4. 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
  5. 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
  6. 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.Google Scholar
  7. Borkovec, T. D. (2002). Life in the future versus life in the present. Clinical Psychology: Science and Practice, 9, 76–80.Google Scholar
  8. 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.Google Scholar
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum.Google Scholar
  18. Cohen, J., & Cohen, P. (1975). Applied multiple regression/correlation analysis for the behavioral sciences. Potomac, Maryland: Lawrence Erlbaum.Google Scholar
  19. Connor, K. M., & Davidson, J. R. T. (1998). Generalized anxiety disorder: Neurobiological and pharmacotherapeutic perspectives. Biological Psychiatry, 44, 1286–1294.Google Scholar
  20. 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
  21. 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
  22. 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
  23. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.Google Scholar
  24. 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
  25. Goldstein, A. J., & Chambless, D. L. (1978). A reanalysis of agoraphobia. Behavior Therapy, 9, 47–59.Google Scholar
  26. Greenberg, L. S., & Safran, J. D. (1987). Emotions in psychotherapy. New York: Guilford.Google Scholar
  27. 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.Google Scholar
  28. 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
  29. 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
  30. 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
  31. 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
  32. LeDoux, J. E. (1996). The emotion brain: The mysterious underpinnings of emotional life. New York: Simon & Schuster.Google Scholar
  33. Lovibond, S. H., & Lovibond, P. F., (1995). Manual for the Depression Anxiety Stress Scales. Sydney: The Psychology Foundation of Australia.Google Scholar
  34. 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
  35. 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
  36. 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
  37. 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
  38. 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
  39. Orsillo, S. M., & Batten, S. V. (2004). ACT in the treatment of PTSD. Behavior Modification (pp. 77–108).Google Scholar
  40. Purdon, C. (1999). Thought suppression and psychopathology. Behaviour Research and Therapy, 37, 1029–1054.Google Scholar
  41. Reiss, S. (1991). Expectancy theory of fear, anxiety, and panic. Clinical Psychology Review, 11, 141-153.Google Scholar
  42. 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
  43. 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
  44. 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
  45. 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
  46. Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston: Houghton Mifflin Company.Google Scholar
  47. Taylor, S. (1995). Anxiety sensitivity: Theoretical perspectives and recent findings. Behaviour Research and Therapy, 33, 243–258.Google Scholar
  48. 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
  49. 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, 361–368Google Scholar
  50. Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101, 34–52.Google Scholar
  51. Wells, A. (2002). GAD, metacognition, and mindfulness: An information processing analysis. Clinical Psychology: Science and Practice, 9, 95–100.Google Scholar
  52. 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
  53. Wells, A., & Papageorgio, C. (1995). Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy, 33, 579–583.Google Scholar
  54. 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

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Lizabeth Roemer
    • 1
    • 4
    Email author
  • Kristalyn Salters
    • 1
  • Susan D. Raffa
    • 2
  • Susan M. Orsillo
    • 3
  1. 1.Department of PsychologyUniversity of Massachusetts at BostonBoston
  2. 2.Boston UniversityBoston
  3. 3.Boston VA Healthcare System and Boston University Medical SchoolBoston
  4. 4.Department of PsychologyUniversity of Massachusetts at BostonBoston

Personalised recommendations