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Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models
Abstract
Generalized anxiety disorder (CAD) is a chronic, pervasive disorder for which we have yet to develop sufficiently efficacious interventions. In this article we propose that recent research and theory regarding this disorder supports the integration of acceptance-based treatments with existing cognitive-behavioral treatments for CAD to improve the efficacy and clinical significance of such approaches. The bases for this proposal (from both the CAD and the acceptance-based treatment literature) are reviewed, and a new treatment stemming from this conceptual integration is described.
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In the citing paper
“Roemer and Orsillo[15, 16] propose a three-part model of GAD that may explain the life dissatisfaction and impairment associated with this disorder.”
From The role of values-consistent behavior in generalized anxiety disorder. (2011) · cites this paper as [15]
In the citing paper
“Further, experiential avoidance may lead to a restriction in behavior as individuals become focused on avoiding events and situations that elicit uncomfortable internal sensations rather than pursuing activities consistent with personal values.”
From The role of values-consistent behavior in generalized anxiety disorder. (2011) · cites this paper as [15]
In the citing paper
“These findings directly lend support to the theoretical model of GAD proposed by Roemer and Orsillo,[15, 39] which suggests that the life impairment in GAD may be partially explained by individuals seeing their internal experiences as distressing, leading to experiential avoidance and a restriction in pursuing activities consistent with personal values.”
From The role of values-consistent behavior in generalized anxiety disorder. (2011) · cites this paper as [15]
In the citing paper
“Roemer and Orsillo (2002) developed a model of GAD informed by research and theory highlighting the potential roles of experiential avoidance (e.g., Hayes, Wilson, Gifford, Follette & Strosahl, 1996) and ruminative, self-critical processing (e.g., Barnard & Teasdale, 1991) in the development and maintenance of psychopathology.”
From A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder (2013) · cites this paper as Roemer & Orsillo, 2002
In the citing paper
“Worry has been proposed as a way of avoiding anxiety (Borkovec, Robinson, Pruzinsky & DePree, 1983), as a form of experiential avoidance (Roemer & Orsillo, 2002) and a way of reducing uncertainty (Dugas, Gagnon, Ladouceur & Freeston, 1998).”
From The Argentinian version of the cognitive fusion questionnaire: Psychometric properties and the role of cognitive fusion as a predictor of pathological worry (2022) · cites this paper as Roemer & Orsillo, 2002
In the citing paper
“A growing body of research also suggests that acceptance contributes to effective coping with adversity, reduced stress, and improved emotional well-being.”
From Aspects of acceptance: building a shared conceptual understanding (2024) · cites this paper as Roemer and Orsillo, 2002
In the citing paper
“Empirical evidence supports the role of EA in the onset and maintenance of emotional disorders such as GAD and depression (Roemer and Orsillo, 2002; Boulanger et al., 2010; Ruiz, 2010).”
From A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression (2020) · cites this paper as Roemer and Orsillo, 2002
In the citing paper
“While excessive or unrealistic worry is present in GAD [13], and according to theresearch its function may be to diminish internal distress by decreasing theexperi ence ofuncertainty, theexposure to uncertainty may lead to more optimal functioning and thus it should be incor porated into treatment [15].”
From The effectiveness of acceptance and commitment therapy-based intervention in therapy for mental health disorders - case study (2020) · cites this paper as [15]
In the citing paper
“Thefunction ofworry in anindividual with GAD is to decrease theper ceived possibility of the occurrence of negative events and to reduce asense ofuncertainty and unpredictability [15, 16].”
From The effectiveness of acceptance and commitment therapy-based intervention in therapy for mental health disorders - case study (2020) · cites this paper as [15]
In the citing paper
“In AMW, worry is conceptualised as aform ofavoidance [15].”
From The effectiveness of acceptance and commitment therapy-based intervention in therapy for mental health disorders - case study (2020) · cites this paper as [15]
In the citing paper
“Second, emerging evidence from the face-to-face treatment literature suggests that mindfulness training may be particularly useful in directly addressing the transdiagnostic mechanisms underlying depression and anxiety such experiential avoidance (Hayes et al., 1996; Roemer and Orsillo, 2002; Roemer et al., 2013), repetitive negative thinking (Watkins et al., 2007; Kingston et al., 2007), and”
From Online mindfulness-enhanced cognitive behavioural therapy for anxiety and depression: Outcomes of a pilot trial (2018) · cites this paper as Roemer and Orsillo, 2002
In the citing paper
“After a decade of observations and studies, therapeutic mindfulness approaches have shown positive effects in patients with anxiety disorders [59, 60], posttraumatic stress disorder [61], substance abuse [62, 63], eating disorders [12, 64], depression [53], and personality disorders [41].”
From Mindful emotion regulation: Exploring the neurocognitive mechanisms behind mindfulness (2015) · cites this paper as [60]
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Walach, H. (2009) · Cited by 15
MINDFULNESS AND SELF-DEVELOPMENT IN PSYCHOTHERAPY
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Issues of measurement and mechanism in meta-analyses: Comment on Westen and Morrision (2001).
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The influence of worry and avoidance on the Iowa Gambling Task
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Metadata
- Authors
- Roemer, L., & Orsillo, S. M.
- Affiliations
- University of Massachusetts Boston (US)
- Boston University (US)
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2002
- Volume
- 9
- Issue
- 1
- Pages
- 54-68
- ISSN
- 0969-5893 (ISSN-L)
- 1468-2850
- OpenAlex
- W2098474483
- Cited by
- 621
- References
- 104
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 15 · 2023: 15 · 2022: 20 · 2021: 28 · 2020: 37 · 2019: 25 · 2018: 28 · 2017: 25 · 2016: 35 · 2015: 20 · 2014: 31 · 2013: 40 · 2012: 26
- FWCI
- 28.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Science and Practice (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- generalized anxiety disorder, mindfulness-based interventions, acceptance and commitment therapy, cognitive behavioral therapy, treatment integration, conceptual blending, treatment efficacy
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