Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is a chronic psychiatric condition characterized primarily by excessive and uncontrollable worry. Although the core feature is cognitive in nature, the somatic complaints and impairment in behavioral functioning associated with worry are major components of GAD. Worry can be defined as "a cognitive process in which individuals anticipate threatening outcomes and events" (Hazlett Stevens, 2008, p. 1) Individuals with GAD usually spend a large proportion of the day engaging in worry that is considered excessive because it is disproportionate to actual risk. In specific, negative outcomes of even the most benign situations are usually overestimated, which leads to a constant state of hypervigilance. The 12 month and lifetime prevalence rates of GAD are estimated at 3.1% and 5.7% respectively, with an average age onset of 31 years (Kessler et al. 2005; Kessler, Chiu, Demler, Walters, 2005) Barlow's (2002) integrative model of anxiety is the predominant model applied specifically to GAD (Roemer, Orsillo, Barlow, 2002) and asserts that a diathesis of biological vulnerabilities (e.g. genetics) and psychological vulnerabilities (e.g. early life experiences characterized by unpredictability and lack of control) is responsible for the development of anxiety disorders. Indeed, GAD has been coined the "basic" anxiety disorder because the anxiety provoking cognitive process underlying GAD is observed across other anxiety disorders with greater specificity, such as worry about social rejection in social anxiety disorder. Individuals who develop GAD are often intolerant of uncertainty and engage in persistent "what if?" and worst case scenario thinking patterns to anticipate perceived catastrophe. In addition to this attempt to thwart external catastrophes, Borkovec and colleagues' avoidance model (Borkovec, Alcaine, Behar, 2004) further proposed that worry serves as a strategy to escape unwanted internal experiences, such as aversive imagery, physiological arousal, and difficult emotions. Content of worry can run the gamut from work performance and finances to health and relationships. In addition to overestimation of negative outcomes, individuals with GAD commonly perceive themselves as unable to cope with anticipated outcomes. Ironically, worrying yields prediction of potential negative outcomes but is often followed by anxiety and ineffective coping rather than constructive problem solving. Worry is believed to function as an illusory attempt at gaining control within the inherent unpredictability of life; such attempts are then negatively reinforced by the absence of catastrophic outcomes.