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Worry and Generalized Anxiety Disorder: A Review and Theoretical Synthesis of Evidence on Nature, Etiology, Mechanisms, and Treatment
Open accessAbstract
Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.
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“Although small studies have suggested that pure GAD is associated with less severe disability than other diagnoses, larger studies have demonstrated that the functional impairment associated with GAD is equivalent and sometimes greater than that of other diagnoses (see Newman et al., 2013 for a review).”
From The increase in interest in GAD: Commentary on Asmundson & Asmundson (2018) · cites this paper as Newman et al., 2013
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“and to be similar in nature to trait anxiety, in that both are persistent, high, and diffuse anxiety states that can impair an individual’s functioning and that may serve as a common transdiagnostic experience in anxious individuals (Newman et al., 2013).”
From The increase in interest in GAD: Commentary on Asmundson & Asmundson (2018) · cites this paper as Newman et al., 2013
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“The worry and anxiety that characterizes GAD has been conceptualized to underlie all emotional diagnoses (Newman et al., 2013)”
From The increase in interest in GAD: Commentary on Asmundson & Asmundson (2018) · cites this paper as Newman et al., 2013
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“GAD is chronic and unlikely to spontaneously remit (Newman, Llera, Erickson, Przeworski, & Castonguay, 2013).”
From The increase in interest in GAD: Commentary on Asmundson & Asmundson (2018) · cites this paper as Newman et al., 2013
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“as well as increased rates of health problems (Newman et al., 2013).”
From The increase in interest in GAD: Commentary on Asmundson & Asmundson (2018) · cites this paper as Newman et al., 2013
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“Relatedly, an exemplary moderated mediation analysis using RCT data showed that acting with awareness mediated the effect of MEMI versus waitlist on distress among non-depressed school employees [39]; despite that, this study only examined one trait mindfulness domain as a mediator.”
From Treatment condition as a moderator and change in trait mindfulness as a mediator of a brief mindfulness ecological momentary intervention for generalized anxiety disorder (2024) · cites this paper as [39]
Experimental — accuracy not yet measuredIn the citing paper
“For example, verbalizing a fearful situation can induce less cardiovascular response than visually imagining the same situation, possibly because verbalizations are used as a strategy for abstraction and disengagement (Borkovec et al., 1998; but also see Newman & Llera, 2011, and Newman, Llera, Erickson, Przeworski, & Castonguay, 2013, who did not find support for this).”
From Toward a Cognitive-Behavioral Classification System for Mental Disorders (2014) · cites this paper as Newman, Llera, Erickson, Przeworski, & Castonguay, 2013
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“Anthroposophic AT is a treatment that is tailored to the individual, with could partially explain the positive results: patients with severe symptoms, comorbidities and a chronic course appear to be better treatable with a therapy that is adapted to the individual, in terms of intensity and focus (Newman et al., 2013).”
From The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial (2019) · cites this paper as Newman et al., 2013
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“All these simultaneously result in more co-occurring negative emotions and physical arousal symptoms [ 66 ].”
From Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis (2023) · cites this paper as [66]
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Zainal, N. H., & Newman, M. G. (2024) · Psychological Medicine · doi:10.1017/s0033291724001958 · Cited by 4
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Metadata
- Authors
- Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., & Castonguay, L. G.
- Affiliations
- Pennsylvania State University (US)
- Towson University (US)
- Seattle Pacific University (US)
- Case Western Reserve University (US)
- Venue
- Annual Review of Clinical Psychology
- Publisher
- Annual Reviews
- Published
- 2013-03-28
- Volume
- 9
- Issue
- 1
- Pages
- 275-297
- ISSN
- 1548-5943 (ISSN-L)
- 1548-5951
- PMC
- PMC4964851
- OpenAlex
- W2166975679
- Cited by
- 472
- References
- 140
- Citations by year
- 2026: 36 · 2025: 43 · 2024: 56 · 2023: 42 · 2022: 57 · 2021: 45 · 2020: 37 · 2019: 32 · 2018: 29 · 2017: 39 · 2016: 20 · 2015: 17 · 2014: 15 · 2013: 3
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annual Review of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- ScholarSphere (Penn State Libraries) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (R01MH039172)
- 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 › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- generalized anxiety disorder, worry, contrast sensitivity, negative affect, risk factors, anxiety treatment, avoidance, emotion regulation
- MeSH terms
- Anxiety Disorders, Emotions, Humans, Models, Psychological, Evidence-Based Medicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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