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Cited by 148Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObsessive-Compulsive Spectrum DisordersPsychological Treatments and Assessments

AVOIDANCE, SAFETY BEHAVIOR, AND REASSURANCE SEEKING IN GENERALIZED ANXIETY DISORDER: Research Article: Behavioral Symptoms in GAD

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Beesdo-Baum, Katja, Jenjahn, Elsa, Höfler, Michael, Lueken, Ulrike, Becker, Eni S., Hoyer, Jürgen·2012·Depression and Anxiety
DOI 10.1002/da.21955
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Abstract

BACKGROUND: The behavioral symptoms of Generalized Anxiety Disorder (GAD) are not well characterized. This study examines behavioral symptoms in patients with GAD compared to healthy participants, their change during behavioral therapy, and their role for predicting short- and long-term outcome. METHODS: Secondary data analysis of 56 patients with DSM-IV GAD from a randomized controlled trial testing worry exposure (n = 29) and applied relaxation (n = 27), compared to 33 demographically matched healthy participants. Participants reported on attempts to control or prevent worry, specifically cognitive and behavioral avoidance, safety behavior, and reassurance, along with other GAD symptoms. The Hamilton Anxiety Scale served as immediate (post therapy) and the Penn State Worry Questionnaire as immediate and long-term (6-/12-month follow-up) treatment outcome measure. RESULTS: GAD patients engage significantly more in attempts to control or prevent worry as reflected in cognitive and behavioral avoidance, safety behavior, and reassurance seeking than healthy comparison participants. Behavior therapy significantly reduces these behavioral strategies without substantial indication of differential effects of treatment type. However, only patients remitting from GAD reach the low symptom level of healthy participants. The initial level of behavioral symptoms is irrelevant for immediate treatment success, but higher degrees of cognitive and behavioral avoidance and safety behavior at the end of treatment predict worse long-term outcome. CONCLUSIONS: Behavioral symptoms appear to be relevant features in GAD that improve with successful treatment. Further research is warranted to examine whether inclusion of behavioral symptoms in the definition of GAD would have beneficial effects on diagnostic recognition and treatment.

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  • Avoidance strategies do not predict treatment response to worry exposure, but higher cognitive and behavioral avoidance at posttest predicts poorer outcomes at follow-up.

    “avoidance strategies did not predict treatment response to worry exposure, but higher cognitive and behavioral avoidance (e.g., safety behaviors) at posttest predicted poorer outcomes at follow-up [26].”

    From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [26]

    The ‘Behavioral Symptoms as Predictors for Immediate and Long-Term Treatment Outcome’ section (page unavailable) reports that higher posttreatment cognitive and behavioral avoidance predicted worse outcomes at 6- and/or 12-month follow-up. It also reports an exception to the claim about immediate response: higher pretreatment safety behavior predicted a worse posttreatment anxiety score. The predictor findings concern patients receiving either worry exposure or applied relaxation, not worry exposure alone. (LLM, conf=0.86)

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  • IU contributes to avoidance, reassurance seeking, planning for worst-case scenarios, and excessive caution.

    “Moreover, IU contributes to avoidance, seeking reassurance, planning for worst-case scenarios, and excessive caution (Beesdo‐Baum et al., 2012).”

    From Intolerance of Uncertainty and Health-Related Anxiety in Youth amid the COVID-19 Pandemic: Understanding and Weathering the Continuing Storm (2022) · cites this paper as Beesdo‐Baum et al., 2012

    The Assessments section lists avoidance, reassurance seeking, making plans in case worries come true, and acting carefully as behaviors assessed in patients with generalized anxiety disorder. The Introduction also describes reassurance seeking as a way to reduce uncertainty. But the paper does not establish that intolerance of uncertainty (IU) causes or contributes to those behaviors; it assesses them as responses to worry. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Among remitters, worry exposure is associated with less reduction in reassurance seeking than applied relaxation.

    “in secondary analyses among remitters, worry exposure was associated with less reduction in reassurance seeking relative to AR [26].”

    From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [26]

  • Because worry was found to be linked to safety behavior, health-related internet use may be an activity performed to reduce health worries.

    “As worry was found to be linked to safety behavior [80], the authors suggest that health-related internet use may be an activity performed to reduce health worries.”

    From Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis (2021) · cites this paper as [80]

  • Higher levels of posttreatment cognitive and behavioural avoidance predicted greater worry at follow-up in an analysis of the effects of two behaviour therapies on GAD symptom severity.

    “Beesdo-Baum et al. (2012) found that higher levels of posttreatment cognitive and behavioural avoidance predicted greater worry at follow-up in their analysis of the effects of two behaviour therapies on GAD symptom severity.”

    From The Mediating Relationship between Maladaptive Behaviours, Cognitive Factors, and Generalised Anxiety Disorder Symptoms (2018) · cites this paper as Beesdo-Baum et al. (2012)

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1 of the 32 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [1]1. Hoyer J, Beesdo K, Becker ES, et al. Epidemiologie und nosol- ogischer Status der Generalisierten Angstst örung. [Prevalence and nosological status of generalized anxiety disorder]. Zeitschrift f ür Klinische Psychologie und Psychotherapie 2003;32:267- 275.
  2. [26]26. Hoyer J, Beesdo-Baum K. Prolonged imaginal exposure based on worry scenarios. In: Neudeck P, Wittchen H-U, editors. Expo- sure Therapy: Rethinking the Model-Refining the Method. New York: Springer, in press.
  3. [30]30. St öber J. Besorgnis: Ein Vergleich dreier Inventare zur Erfassung allgemeiner Sorgen. Zeitschrift f ür Differentielle und Diagnostis- che Psychologie 1995;16:50-63.

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Authors
Beesdo-Baum, K., Jenjahn, E., Höfler, M., Lueken, U., Becker, E. S., & Hoyer, J.
Affiliations
  • Institute of Clinical Psychology and Psychotherapy; Technische Universitaet Dresden; Germany
  • Technische Universität Dresden (DE)
  • Radboud University Nijmegen (NL)
ORCID
Venue
Depression and Anxiety
Publisher
Hindawi Limited
Published
2012-05-11
Volume
29
Issue
11
Pages
948-957
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.21955
OpenAlex
W2154478784
Cited by
148
References
32
Citations by year
2026: 7 · 2025: 7 · 2024: 9 · 2023: 19 · 2022: 14 · 2021: 13 · 2020: 15 · 2019: 13 · 2018: 18 · 2017: 8 · 2016: 7 · 2015: 7 · 2014: 6 · 2013: 2 · 2012: 1
FWCI
6.87
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1208 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
Deutsche Forschungsgemeinschaft
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
generalized anxiety disorder, behavioral avoidance, safety behavior, reassurance seeking, applied relaxation, treatment outcome prediction, long-term outcomes, remission, behavioral symptoms
MeSH terms
Adult, Anxiety Disorders, Behavioral Symptoms, Female, Humans, Male, Middle Aged, Relaxation Therapy, Cognitive Behavioral Therapy, Case-Control Studies, Randomized Controlled Trials as Topic, Treatment Outcome

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