Generalized Anxiety Disorder

  • Richard M. Suinn


Generalized anxiety disorder is the human disorder previously referred to as anxiety neurosis and sometimes described as free-floating or pervasive anxiety. One estimate is that such anxiety disorders occur in 2% to 5% of the population in the United States and Britain (Marks & Lader, 1973). Generalized anxiety disorder differs from panic disorder in being a more persistent, chronic condi tion of tension, while panic disorder appears to be characterized by recurring experiences of extreme tension. Hence there are differences in duration and in intensity. A person suffering from generalized anxiety disorder often complains, “I’m constantly tense and jumpy all the time … it’s like I know something dreadful is going to happen … my hands are clammy, I can’t concentrate … it’s affecting my whole life.” In contrast, one client diagnosed as suffering from panic disorder reported, “I was riding my bicycle … and suddenly … my heart was going so fast I was sure I was having a heart attack. I wanted to hide somewhere … I was petrified … I thought … I’m going mad … the fright … made me want to scream” (Suinn, 1981a). A distinction should be made between the generalized anxiety disorder and the phobic disorder since both are characterized by similar patterns of responses, such as autonomic arousal, somatic-behavioral disruptions such as trembling, and cognitive responses such as worrying. A major distinction is that phobic disorders are characterized according to the stimulus aspects of the disorders. Phobic disorders are associated with distinctive cue conditions which, when present, precipitate the fear reaction.


Generalize Anxiety Disorder Trait Anxiety Cognitive Therapy Irrational Belief Test Anxiety 
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  1. Agras, W., Leitenberg, H., &Barlow, D. Social reinforcement in the modification of agorapho bia. Archives of General Psychiatry ,1968, 19 ,423–427.PubMedCrossRefGoogle Scholar
  2. Agras, W., Leitenberg, H., Barlow, D., &Thomson, L. Instructions and reinforcement in the modification of neurotic behavior. American Journal of Psychiatry ,1969, 125 ,1435–1439.PubMedGoogle Scholar
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, D.C.: Author, 1980.Google Scholar
  4. Bandura, A. Influence of model’s reinforcement contingencies on the acquisition of imitative responses. Journal of Personality and Social Psychology ,1965, 1 ,589–595.CrossRefGoogle Scholar
  5. Bandura, A. Social learning theory. Englewood Cliffs, N.J.: Prentice-Hall, 1977.Google Scholar
  6. Beck, A., Laude, R., &Bohnert, M. Ideation components of anxiety neurosis. Archives of General Psychiatry ,1974, 31 ,319–325.PubMedCrossRefGoogle Scholar
  7. Bloom, L., &Cantrell, D. Anxiety management training for essential hypertension in pregnancy. Behavior Therapy ,1978, 9 ,377–382.CrossRefGoogle Scholar
  8. Borkovec, T., Kaloupek, D., &Slama, K. The facilitative effect of muscle tension-release in the relaxation treatment of sleep disturbance. Behavior Therapy ,1975, 6 ,301–309.CrossRefGoogle Scholar
  9. Brauer, A., Horlick, L., Nelson, E., Farquhar, J., &Agras, W. Relaxation therapy for essential hypertension: A Veterans’ Administration outpatient study. Journal of Behavioral Medicine ,1979, 2 ,21–29.PubMedCrossRefGoogle Scholar
  10. Brooks, G., &Richardson, F. Emotional skills training: A treatment program for duodenal ulcer. Behavior Therapy ,1980, 11 ,198–207.CrossRefGoogle Scholar
  11. Burns, D., &Beck, A. Cognitive behavior modification of mood disorders. In J. P. Foreyt &D. P. Rathjen (Eds.), Cognitive behavior therapy: Research and application. New York: Plenum, 1978.Google Scholar
  12. Chesney, M., &Tasto, D. The effectiveness of behavior modification with spasmodic and congestive dysmenorrhea. Behaviour Research and Therapy ,1975, 13 ,245–253.PubMedCrossRefGoogle Scholar
  13. Dalessio, D. Wolff’s headache and other head pain. New York: Oxford University Press, 1972.Google Scholar
  14. Deffenbacher, J., &Hahnloser, R. Cognitive and relaxation coping skills in stress inoculation. Cognitive Therapy and Research ,1981, 5 ,211–216.CrossRefGoogle Scholar
  15. Deffenbacher, J., &Michaels, A. A twelve-month follow-up of homogeneous and heterogeneous anxiety management training. Journal of Counseling Psychology ,1981, 28 ,463–466. (a)CrossRefGoogle Scholar
  16. Deffenbacher, J., &Michaels, A. Anxiety management training and self-control desensitiza-tion-15 months later. Journal of Counseling Psychology ,1981, 28 ,459–462. (b)CrossRefGoogle Scholar
  17. Deffenbacher, J., &Shelton, J. A comparison of anxiety management training and desensitiza-tion in reducing test and other anxieties. Journal of Counseling Psychology ,1978, 25 ,277– 282.CrossRefGoogle Scholar
  18. Deffenbacher, J., &Suinn, R. The self-control of anxiety. In P. Karoly &F. H. Kanfer (Eds.), The psychology of self-management: From theory to practice. Elmsford, New York: Per-gamon, 1982.Google Scholar
  19. Deffenbacher, J., Michaels, A., Daley, P., &Michaels, T. A comparison of homogeneous and heterogeneous anxiety management training. Journal of Counseling Psychology ,1980, 27, 630–634.CrossRefGoogle Scholar
  20. Deffenbacher, J., Michaels, A., Michaels, T., &Daley, P. Comparison of anxiety management training and self-control desensitization. Journal of Counseling Psychology ,1980, 27 ,232– 239.CrossRefGoogle Scholar
  21. Edie, C. Uses of AMT in treating trait anxiety. Unpublished doctoral dissertation, Colorado State University, Fort Collins, Col., 1972.Google Scholar
  22. Ellis, A. Reason and emotion in psychotherapy. New York: Lyle Stuart, 1962.Google Scholar
  23. Emmelkamp, P., Kuipers, A., &Eggeraat, J. Cognitive modification versus prolonged exposure in vivo: A comparison with agoraphobics as subjects. Behaviour Research and Therapy, 1978, 16 ,33–41.PubMedCrossRefGoogle Scholar
  24. Epstein, L., Webster, J., &Abel, G. Self-managed relaxation in the treatment of tension headaches. In J. Krumboltz &C. Thoresen (Eds.), Counseling methods. New York: Holt, Rine-hart &Winston, 1976.Google Scholar
  25. Eysenck, H., &Rachman, S. The causes and cures of neurosis. London: Routledge &Kegan, 1965.Google Scholar
  26. Girodo, M., &Roehl, J. Cognitive preparation and coping self-talk: Anxiety management during the stress of flying. Journal of Consulting and Clinical Psychology ,1978, 46 ,978–989.PubMedCrossRefGoogle Scholar
  27. Goldfried, M., &Trier, C. Effectiveness of relaxation as an active coping skill. Journal of Abnor mal Psychology ,1974, 83 ,348–355.CrossRefGoogle Scholar
  28. Goldfried, M., Decenteceo, E., &Weinberg, L. Systematic rational restructuring as a self-control technique. Behavior Therapy ,1974, 5 ,247–254.CrossRefGoogle Scholar
  29. Goldfried, M., Linehan, M., &Smith, J. Reduction of test anxiety through cognitive restructuring. Journal of Consulting and Clinical Psychology ,1978, 46 ,32–39.PubMedCrossRefGoogle Scholar
  30. Hammen, C., Jacobs, M., Mayol, A., &Cochran, S. Dysfunctional cognitions and the effectiveness of skills and cognitive-behavioral assertion training. Journal of Consulting and Clinical Psychology ,1980, 48 ,685–695.PubMedCrossRefGoogle Scholar
  31. Hersen, M., &Bellack, A. Social skills training for chronic psychiatric patients: Rationale, research findings and future directions. Comparative Psychiatry ,1976, 17 ,559–580.CrossRefGoogle Scholar
  32. Home, A., &Matson, J. A comparison of modeling, desensitization, flooding, study skills, and control groups for reducing test anxiety. Behavior Therapy ,1977, 8 ,1–8.CrossRefGoogle Scholar
  33. Houston, B., Jorgensen, R., &Zurawski, R. The effectiveness of anxiety management training in reducing hypertensives’ blood pressure at rest and following stress. In Program abstracts and meeting information. Society of Behavioral Medicine, Second Annual Meeting, New York, 1980.Google Scholar
  34. Hugdahl, K. The three-systems-model of fear and emotion-a critical examination. Behaviour Research and Therapy ,1981, 19 ,75–85.PubMedCrossRefGoogle Scholar
  35. Hussian, R., &Lawrence, P. The reduction of test, state, and trait anxiety by test-specific and generalized stress inoculation training. Cognitive Therapy and Research ,1978, 2 ,25–37.CrossRefGoogle Scholar
  36. Hutchings, D., Denney, D., Basgall, J., &Houston, B. Anxiety management and applied relaxation in reducing general anxiety. Behaviour Research and Therapy ,1980, 18 ,181–190.PubMedCrossRefGoogle Scholar
  37. Jacobsen, F. Progressive relaxation. Chicago, Ill.: University of Chicago Press, 1938.Google Scholar
  38. Jannoun, L., Munby, M., Catalan, J., &Gelder, M. A home-based treatment program for agoraphobia: Replication and controlled evaluation. Behavior Therapy ,1980, 11 ,294–305.CrossRefGoogle Scholar
  39. King, M. Anxiety management training for general medical patients. Unpublished doctoral dissertation, Colorado State University, Fort Collins, 1981.Google Scholar
  40. Kleinknecht, R., &Bernstein, D. Short-term treatment of dental avoidance. Journal of Behavior Therapy and Experimental Psychiatry ,in press.Google Scholar
  41. Lang, P. The application of psychophysiological methods to the study of psychotherapy and behavior change. In A. Bergin &S. Garfield (Eds.), Handbook of psychotherapy and behavior change. New York: Wiley, 1971.Google Scholar
  42. Lazarus, A., &Abramovitz, A. The use of “emotive imagery” in the treatment of children’s phobias. Journal of Mental Science ,1962, 108 ,191–195.PubMedGoogle Scholar
  43. Ledwidge, B. Cognitive behavior modification: A step in the wrong direction? Psychological Bulletin ,1978, 85 ,353–375.PubMedCrossRefGoogle Scholar
  44. Lehrer, P. Psychophysiological effects of progressive relaxation in anxiety neurotic patients and of progressive relaxation and alpha feedback in nonpatients. Journal of Consulting and Clinical Psychology ,1978, 46 ,389–404.PubMedCrossRefGoogle Scholar
  45. Leitenberg, H. Behavioral approaches to the treatment of neuroses. In H. Leitenberg (Ed.), Handbook of behavior modification and behavior therapy. Englewood Cliffs, N.J.: Prentice-Hall, 1976.Google Scholar
  46. Leitenberg, H., Agras, W., Thomson, L., &Wright, D. Feedback in behavior modification: An experimental analysis in two phobic cases. Journal of Applied Behavior Analysis ,1968, 1 ,131–137.PubMedCrossRefGoogle Scholar
  47. Leitenberg, H., Agras, W., Edwards, J., Thomson, L., &Wincze, J. Practice as a psychothera-peutic variable. An experimental analysis within single cases. Journal of Psychiatric Research ,1970, 7, 215–225.PubMedCrossRefGoogle Scholar
  48. Leitenberg, H., Agras, W., Butz, R., &Wincze, J. Relationship between heart rate and behavior change during the treatment of phobias. Journal of Abnormal Psychology ,1971, 78 ,59– 68.PubMedCrossRefGoogle Scholar
  49. Leitenberg, H., Agras, W., Allen, R., Butz, R., &Edwards, J. Feedback and therapist praise during treatment of phobia. Journal of Consulting and Clinical Psychology ,1975, 43 ,396– 404.PubMedCrossRefGoogle Scholar
  50. Lewis, C., Biglan, A., &Steinbock, E. Self-administered relaxation training and money deposits in the treatment of recurrent anxiety. Journal of Consulting and Clinical Psychology ,1978, 46 ,1274–1283.PubMedCrossRefGoogle Scholar
  51. Lick, J., &Heffler, D. Relaxation training and a tension placebo in the treatment of severe insomnia. Journal of Consulting and Psychology ,1977, 45 ,153–161.CrossRefGoogle Scholar
  52. Linehan, M., Goldfried, M., &Goldfried, A. Assertion therapy: Skill training or cognitive restructuring. Behavior Therapy ,1979, 10 ,372–388.CrossRefGoogle Scholar
  53. Lipsky, M., Kassinove, H., &Miller, N. Effects of rational-emotive imagery on the emotional adjustment of community mental health center patients. Journal of Consulting and Clinical Psychology ,1980, 48 ,366–374.PubMedCrossRefGoogle Scholar
  54. Mahoney, M. The self management of covert behavior: A case study. Behavior Therapy ,1971, 2 ,575–578.CrossRefGoogle Scholar
  55. Marks, I., &Lader, M. Anxiety states (anxiety neurosis): A review. Journal of Nervous and Mental Disorders ,1973, 156 ,3–18.CrossRefGoogle Scholar
  56. Mathis, H. The effects of anxiety management training on musical performance anxiety. Unpublished master’s thesis, Colorado State University, Fort Collins, 1978.Google Scholar
  57. Meichenbaum, D. Examination of model characteristics in reducing avoidance behavior. Journal of Personality and Social Psychology ,1971, 17 ,298–307.CrossRefGoogle Scholar
  58. Meichenbaum, D. Cognitive modification of test anxious college students. Journal of Consulting and Clinical Psychology ,1972, 39 ,370–380.PubMedCrossRefGoogle Scholar
  59. Meichenbaum, D. Cognitive-behavior modification: An integrative approach. New York: Plenum, 1977.Google Scholar
  60. Meichenbaum, D., Gilmore, J., &Fedoravicius, A. Group insight versus group desensitization in treating speech anxiety. Journal of Consulting and Clinical Psychology ,1971, 36 ,410– 421.PubMedCrossRefGoogle Scholar
  61. Melamed, B., &Siegel, L. Reduction of anxiety in children facing hospitalization and surgery by use of filmed modeling. Journal of Consulting and Clinical Psychology ,1975, 43 ,511– 521.PubMedCrossRefGoogle Scholar
  62. Melamed, B., &Siegel, L. Behavioral medicine, practical applications in health care. New York: Springer, 1980.Google Scholar
  63. Miller, N., &Kassinove, H. Effects of lecture, rehearsal, written homework, and IG on the efficacy of a rational emotive school mental health program. Journal of Community Psychology ,1978, 6 ,366–373.Google Scholar
  64. Mitchell, K., &Ng, K. Effects of group counseling and behavior therapy on the academic achievement of test-anxious students. Journal of Counseling Psychology ,1973, 19 ,491– 497.CrossRefGoogle Scholar
  65. Mowrer, O. Learning theory and the symbolic process. New York: Wiley, 1960.CrossRefGoogle Scholar
  66. Nally, M. AMT: A treatment for delinquents. Unpublished doctoral dissertation, Colorado State University, Fort Collins, 1975.Google Scholar
  67. Nicassio, P., &Bootzin, R. A comparison of progressive relaxation and autogenic training as treatments for insomnia. Journal of Abnormal and Social Psychology ,1974, 83 ,253– 260.CrossRefGoogle Scholar
  68. Nicoletti, J. Anxiety management training. Unpublished doctoral dissertation, Colorado State University, Fort Collins, 1972.Google Scholar
  69. Patel, C. 12-month follow-up of yoga and biofeedback in the management of hypertension. Lan cet ,1975, 1 ,62–67.Google Scholar
  70. Peterson, L., &Ridley-Johnson, R. Pediatric hospital response to survey on prehospital preparation for children. Journal of Pediatric Psychology ,1980, 5 ,1–7.PubMedCrossRefGoogle Scholar
  71. Peterson, L., &Shigetomi, C. The use of coping techniques to minimize anxiety in hospitalized children. Behavior Therapy ,1981, 12 ,1–14.CrossRefGoogle Scholar
  72. Raskin, M., Johnson, G., &Rondestveldt, J. Chronic anxiety treated by feedback-induced muscle relaxation. Archives of General Psychiatry ,1973, 28 ,263–267.PubMedCrossRefGoogle Scholar
  73. Richardson, F., &Suinn, R. The mathematics anxiety rating scale: Psychometric data. Journal of Counseling Psychology ,1973, 19 ,551–554.CrossRefGoogle Scholar
  74. Ritter, B. The group desensitization of children’s snake phobias using vicarious and contact desensitization procedures. Behaviour Research and Therapy ,1968, 6 ,1–6.PubMedCrossRefGoogle Scholar
  75. Rosenthal, T., &Bandura, A. Psychological modeling: Theory and practice. In S. Garfield &A. Bergin (Eds.), Handbook of psychotherapy and behavior change: An empirical analysis (2nd ed.) New York: Wiley, 1978.Google Scholar
  76. Rudenstam, K., &Bedrosian, R. An investigation of the effectiveness of desensitization and flooding with two types of phobia. Behaviour Research and Therapy ,1977, 15 ,23–30.CrossRefGoogle Scholar
  77. Sherman, A. Two-year follow-up of training in relaxation as a behavioral self-management skill. Behavior Therapy ,1975, 6 ,419–420.CrossRefGoogle Scholar
  78. Sherman, A., &Plummer, I. Training in relaxation as a behavioral self-management skill: An exploratory investigation. Behavior Therapy ,1973, 4 ,543–550.CrossRefGoogle Scholar
  79. Shipley, R., &Boudewyns, P. Flooding and implosive therapy: Are they harmful? Behavior Therapy ,1980, 11 ,503–508.CrossRefGoogle Scholar
  80. Shoemaker, J. Treatments for anxiety neurosis. Unpublished doctoral dissertation, Colorado State University, Fort Collins, 1976.Google Scholar
  81. Silver, B., &Blanchard, E. Biofeedback and relaxation training in the treatment of psychophysiological disorders: Or are the machines really necessary? Journal of Behavioral Medicine ,1978, 1 ,217–239.PubMedCrossRefGoogle Scholar
  82. Stampfi\ T. Implosive therapy: The theory, the subhuman analogue, the strategy, and the technique: Part I: The theory. In S. G. Armitage (Ed.), Behavior modification techniques in the treatment of emotional disorders. Battle Creek, Mich.: V. A. Publication, 1967.Google Scholar
  83. Stampfl, T., &Levis, D. Essential of implosive therapy: A learning-theory-based psychodynamic behavioral therapy. Journal of Abnormal Psychology ,1967, 72 ,496–503.PubMedCrossRefGoogle Scholar
  84. Suinn, R. Manual for anxiety management training (AMT). Fort Collins, Colorado: Rocky Mountain Behavioral Science Institute, 1977 (Available from publisher [P.O. Box 1066, Fort Collins, Col., 90522]). (a)Google Scholar
  85. Suinn, R. Treatment of phobias. In G. Harris (Ed.), The group treatment of human problems. New York: Grune &Stratton, 1977. (b)Google Scholar
  86. Suinn, R. Fundamentals of behavior pathology (3rd ed.). Menlo Park, Cal.: Benjamin/Cummings, 1981. (a)Google Scholar
  87. Suinn, R. Stress management studies: Remedies for alphabet soup. Address presented at Rocky Mountain Psychological Association Convention, Denver, May, 1981. (b)Google Scholar
  88. Suinn, R., &Bloom, L. Anxiety management training for Type A persons. Journal of Behavioral Medicine ,1978, 1 ,25–35.PubMedCrossRefGoogle Scholar
  89. Tarler-Benlolo, L., &Love, W. EMG-biofeedback treatment of spastic colon: A case report. Paper presented to the meeting of the Biofeedback Society of America, Orlando, Fla., March 1977.Google Scholar
  90. Townsend, R., House, J., &Addario, D. A comparison of biofeedback-mediated relaxation and group therapy in the treatment of chronic anxiety. American Journal of Psychiatry ,1975, 132 ,598–601.PubMedGoogle Scholar
  91. Weinberger, A., &Engelhart, R. Three group treatments for reduction of speech anxiety among students. Perceptual Motor Skills ,1976, 43 ,1317–1318.CrossRefGoogle Scholar
  92. Weinstock ,S. The reestablishment of intestinal control in functional colitis. Paper presented at the meeting of the Biofeedback Research Society, Colorado Springs, Col., February, 1976.Google Scholar
  93. Weissberg, M. A comparison of direct and vicarious treatments of speech anxiety: Desensitization, desensitization with coping imagery, and cognitive modification. Behavior Therapy ,1977, 8 ,606–620.CrossRefGoogle Scholar
  94. Wolpe, J. The practice of behavior therapy (2nd ed.). New York: Pergamon, 1973.Google Scholar

Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • Richard M. Suinn
    • 1
  1. 1.Department of PsychologyColorado State UniversityFt. CollinsUSA

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