A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry

Clinical Psychology Review

Volumn 31, Issue 3, 2011, Pages 371-382

  Newman, Michelle G ^a   Llera, Sandra J ^a  

^a PENNSYLVANIA STATE UNIVERSITY   (United States)

Author keywords

Cognitive behavioral therapy; Emotion; Emotion regulation; Emotional avoidance; Emotional processing; Generalized anxiety disorder

Indexed keywords

ANXIETY; AVERSION; AVOIDANCE BEHAVIOR; BEHAVIOR THERAPY; COGNITION; COGNITIVE THERAPY; CONTRAST AVOIDANCE MODEL OF WORRY; DEPRESSION; EMOTION; EMOTIONAL DISORDER; EMOTIONALITY; EXPERIMENTAL MODEL; GENERALIZED ANXIETY DISORDER; HUMAN; IMAGERY; LIFE EVENT; OBSESSIVE COMPULSIVE DISORDER; PANIC; POSTTRAUMATIC STRESS DISORDER; REVIEW; SELF CONTROL; SOCIAL PHOBIA;

ANXIETY; ANXIETY DISORDERS; COGNITIVE THERAPY; EMOTIONS; HUMANS; MODELS, PSYCHOLOGICAL;

EID: 79951567979     PISSN: 02727358     EISSN: 18737811     Source Type: Journal    
DOI: 10.1016/j.cpr.2011.01.008     Document Type: Review

References (138)

1. Albu M. Automatic and intentional inhibition in patients with generalized anxiety disorder. Cognitie Creier Comportament 2008, 12(2):233-249.
2. Andor T., Gerlach A.L., Rist F. Superior perception of phasic physiological arousal and the detrimental consequences of the conviction to be aroused on worrying and metacognitions in GAD. Journal of Abnormal Psychology 2008, 117(1):193-205. 10.1037/0021-843X.117.1.193.
3. Andrews V.H., Borkovec T.D. The differential effects of inductions of worry, somatic anxiety, and depression on emotional experience. Journal of Behavior Therapy and Experimental Psychiatry 1988, 19(1):21-26. 10.1016/0005-7916(88)90006-7.
4. Bacon M.M., Rood E.A., Washburn M.F. A study of affective contrast. (Minor Stud. fr. Psychol. Lab. of Vassar Col., XXV.). American Journal of Psychology 1914, 25(2):290-293. 10.2307/1413417.
5. Behar E., DiMarco I.D., Hekler E.B., Mohlman J., Staples A.M. Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders 2009, 23(8):1011-1023. 10.1016/j.janxdis.2009.07.006.
6. Borkovec T.D. Worry: A potentially valuable concept. Behaviour Research and Therapy 1985, 23(4):481-482. 10.1016/0005-7967(85)90178-0.
7. Borkovec T.D. The nature, functions, and origins of worry. Worrying: Perspectives on theory, assessment and treatment 1994, 5-33. Wiley, Oxford, England. G.C.L. Davey, F. Tallis (Eds.).
8. Borkovec T.D., Alcaine O., Behar E.S. Avoidance theory of worry and generalized anxiety disorder. Generalized anxiety disorder: Advances in research and practice 2004, 77-108. Guilford, New York. R. Heimberg, D. Mennin, C. Turk (Eds.).
9. Borkovec T.D., Costello E. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology 1993, 61(4):611-619. 10.1037/0022-006X.61.4.611.
10. Borkovec T.D., Hazlett-Stevens H., Diaz M.L. The role of positive beliefs about worry in generalized anxiety disorder and its treatment. Clinical Psychology and Psychotherapy 1999, 6(2):126-138. 10.1002/(SICI)1099-0879(199905)6:2<126::AID-CPP193>3.0.CO;2-M.
11. Borkovec T.D., Hu S. The effect of worry on cardiovascular response to phobic imagery. Behaviour Research and Therapy 1990, 28(1):69-73.
12. Borkovec T.D., Inz J. The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy 1990, 28(2):153-158. 10.1016/0005-7967(90)90027-G.
13. Borkovec T.D., Lyonfields J.D., Wiser S.L., Deihl L. The role of worrisome thinking in the suppression of cardiovascular response to phobic imagery. Behaviour Research and Therapy 1993, 31(3):321-324. 10.1016/0005-7967(93)90031-O.
14. Borkovec T.D., Newman M.G. Worry and generalized anxiety disorder. Comprehensive clinical psychology: Vol. 6. Adults: Clinical formulation and treatment 1998, 439-459. Pergamon Press, Oxford, England. A.S. Bellack, M. Hersen (Eds.).
15. Borkovec T.D., Newman M.G., Pincus A.L., Lytle R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology 2002, 70(2):288-298. 10.1037/0022-006X.70.2.288.
16. Borkovec T.D., Robinson E., Pruzinsky T., DePree J.A. Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy 1983, 21(1):9-16. 10.1016/0005-7967(83)90121-3.
17. Borkovec T.D., Roemer L. Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics?. Journal of Behavior Therapy and Experimental Psychiatry 1995, 26(1):25-30.
18. Borkovec T.D., Ruscio A.M. Psychotherapy for generalized anxiety disorder. Journal of Clinical Psychiatry 2001, 62(Supplement 11):37-45.
19. Borkovec T.D., Sides J.K. The contribution of relaxation and expectancy to fear reduction via graded, imaginal exposure to feared stimuli. Behaviour Research and Therapy 1979, 17(6):529-540. 10.1016/0005-7967(79)90096-2.
20. Bouchard S., Gauthier J., Laberge B., French D., Pelletier M.H., Godbout C. Exposure versus cognitive restructuring in the treatment of panic disorder with agoraphobia. Behaviour Research and Therapy 1996, 34(3):213-224. 10.1016/0005-7967(95)00077-1.
21. Bradley B.P., Mogg K., Millar N., White J. Selective processing of negative information: Effects of clinical anxiety, concurrent depression, and awareness. Journal of Abnormal Psychology 1995, 104(3):532-536. 10.1037/0021-843X.104.3.532.
22. Bradley B.P., Mogg K., White J., Groom C., de Bono J. Attentional bias for emotional faces in generalized anxiety disorder. British Journal of Clinical Psychology 1999, 38(3):267-278. 10.1348/014466599162845.
23. Brosschot J.F. Markers of chronic stress: Prolonged physiological activation and (un)conscious perseverative cognition. Neuroscience & Biobehavioral Reviews 2010, 35(1):46-50. doi:10.1016/j.neubiorev.2010.01.004.
24. Brosschot J.F., Gerin W., Thayer J.F. The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research 2006, 60(2):113-124. 10.1016/j.jpsychores.2005.06.074.
25. Brosschot J.F., Pieper S., Thayer J.F. Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology 2005, 30(10):1043-1049. 10.1016/j.psyneuen.2005.04.008.
26. Brosschot J.F., Thayer J.F. Heart rate response is longer after negative emotions than after positive emotions. International Journal of Psychophysiology 2003, 50(3):181-187. 10.1016/s0167-8760(03)00146-6.
27. Brosschot J.F., van Dijk E., Thayer J.F. Prolonged autonomic activation, perseverative negative cognition, and daily stressors. International Congress Series 2002, 1241:329-336. 10.1016/S0531-5131(02)00615-5.
28. Brosschot J.F., Van Dijk E., Thayer J.F. Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period. International Journal of Psychophysiology 2007, 63(1):39-47. 10.1016/j.ijpsycho.2006.07.016.
29. Butler G., Wells A., Dewick H. Differential effects of worry and imagery after exposure to a stressful stimulus: A pilot study. Behavioural and Cognitive Psychotherapy 1995, 23(1):45-56. 10.1017/S1352465800017628.
30. Calmes C., Roberts J. Repetitive thought and emotional distress: Rumination and worry as prospective predictors of depressive and anxious symptomatology. Cognitive Therapy and Research 2007, 31(3):343-356. 10.1007/s10608-006-9026-9.
31. Carter W.R., Johnson M.C., Borkovec T.D. Worry: An electrocortical analysis. Advances in Behaviour Research and Therapy 1986, 8(4):193-204. 10.1016/0146-6402(86)90004-4.
32. Cartwright-Hatton S., Wells A. Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates. Journal of Anxiety Disorders 1997, 11(3):279-296. 10.1016/S0887-6185(97)00011-X.
33. Clark D.M., Ball S., Pape D. An experimental investigation of thought suppression. Behaviour Research and Therapy 1991, 29(3):253-257. 10.1016/0005-7967(91)90115-J.
34. Craske M.G., Kircanski K., Zelikowsky M., Mystkowski J., Chowdhury N., Baker A. Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy 2008, 46(1):5-27. 10.1016/j.brat.2007.10.003.
35. Davey G.C.L. A mood-as-input account of perseverative worrying. Worry and its psychological disorders: Theory, assessment and treatment 2006, 217-237. Wiley, Hoboken, NJ. G.C.L. Davey, A. Wells (Eds.).
36. Davey G.C., Hampton J., Farrell J., Davidson S. Some characteristics of worrying: Evidence for worrying and anxiety as separate constructs. Personality and Individual Differences 1992, 13(2):133-147. 10.1016/0191-8869(92)90036-O.
37. Davey G.C.L., Levy S. Catastrophic worrying: Personal inadequacy and a perseverative iterative style as features of the catastrophizing process. Journal of Abnormal Psychology 1998, 107(4):576-586. 10.1037/0021-843X.107.4.576.
38. Davey G.C.L., Matchett G. Unconditioned stimulus rehearsal and the retention and enhancement of differential " fear" conditioning: Effects of trait and state anxiety. Journal of Abnormal Psychology 1994, 103(4):708-718. 10.1037/0021-843X.103.4.708.
39. Davey G., Startup H., MacDonald C., Jenkins D., Patterson K. The use of " as many as can" versus " feel like continuing" stop rules during worrying. Cognitive Therapy and Research 2005, 29(2):155-169. 10.1007/s10608-005-3162-5.
40. Davey G.C.L., Tallis F., Capuzzo N. Beliefs about the consequences of worrying. Cognitive Therapy and Research 1996, 20(5):499-520. 10.1007/BF02227910.
41. Davis R.N., Valentiner D.P. Does meta-cognitive theory enhance our understanding of pathological worry and anxiety?. Personality and Individual Differences 2000, 29(3):513-526. 10.1016/s0191-8869(99)00211-1.
42. Davison G.C. Relative contributions of differential relaxation and graded exposure to desensitization of a neurotic fear. Proceedings of the Annual Convention of the American Psychological Association 1965, 209-210.
43. Dermer M., Cohen S.J., Jacobsen E., Anderson E.A. Evaluative judgments of aspects of life as a function of vicarious exposure to hedonic extremes. Journal of Personality and Social Psychology 1979, 37(2):247-260. 10.1037/0022-3514.37.2.247.
44. Dua J.K., King D.A. Heart rate and skin conductance as measures of worrying. Behaviour Change 1987, 4(3):26-32.
45. Dugas M., Buhr K., Ladouceur R. The role of intolerance of uncertainty in etiology and maintenance. Generalized anxiety disorder: Advances in research and practice 2004, 143-163. Guilford Press, New York. R. Heimberg, D. Mennin, C. Turk (Eds.).
46. Dugas M.J., Gagnon F., Ladouceur R., Freeston M.H. Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy 1998, 36(2):215-226. 10.1016/S0005-7967(97)00070-3.
47. Dugas M.J., Letarte H., Rheaume J., Freeston M.H., Ladouceur R. Worry and problem solving: Evidence of a specific relationship. Cognitive Therapy and Research 1995, 19(1):109-120. 10.1007/BF02229679.
48. Faure J. Contribution à l'EEG de l'anxiété/Contribution to the EEG in anxiety. Electroencephalography and Clinical Neurophysiology 1949, 1:124-125.
49. Fisher A.J., Granger D.A., Newman M.G. Sympathetic arousal moderates self-reported physiological arousal symptoms at baseline and physiological flexibility in response to a stressor in generalized anxiety disorder. Biological Psychology 2010, 83(3):191-200. 10.1016/j.biopsycho.2009.12.007.
50. Foa E.B., Dancu C.V., Hembree E.A., Jaycox L.H., Meadows E.A., Street G.P. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology 1999, 67(2):194-200. 10.1037/0022-006X.67.2.194.
51. Foa E.B., Kozak M.J. Emotional processing of fear: Exposure to corrective information. Psychological Bulletin 1986, 99(1):20-35. 10.1037/0033-2909.99.1.20.
52. Foa E.B., Steketee G., Grayson J.B. Imaginal and in vivo exposure: A comparison with obsessive-compulsive checkers. Behavior Therapy 1985, 16(3):292-302. 10.1016/s0005-7894(85)80017-4.
53. Francis K., Dugas M.J. Assessing positive beliefs about worry: Validation of a structured interview. Personality & Individual Differences 2004, 37(2):405-415. 10.1016/j.paid.2003.09.012.
54. Freeston M.H., Rheaume J., Letarte H., Dugas M.J., Ladouceur R. Why do people worry?. Personality and Individual Differences 1994, 17(6):791-802. 10.1016/0191-8869(94)90048-5.
55. Frijda N.H. The emotions 1986, Cambridge University Press, Paris, France.
56. Gastaut H., Dongier M., Broughton R., Tassinari C. Electroencephalographic and clinical study of diurnal and nocturnal anxiety in attacks. Electroencephalography and Clinical Neurophysiology 1964, 17:475.
57. Gerin W., Davidson K.W., Christenfeld N.J.S., Goyal T., Schwartz J.E. The role of angry rumination and distraction in blood pressure recovery from emotional arousal. Psychosomatic Medicine 2006, 68(1):64-72. 10.1097/01.psy.0000195747.12404.aa.
58. Glynn L.M., Christenfeld N., Gerin W. The role of rumination in recovery from reactivity: Cardiovascular consequences of emotional states. Psychosomatic Medicine 2002, 64(5):714-726. 10.1097/01.PSY.0000031574.42041.23.
59. Gray J.A. Precis of the neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Behavioral and Brain Sciences 1982, 5(3):469-534. 10.1017/S0140525X00012851.
60. Grayson J.B., Borkovec T.D. The effects of expectancy and imagined response to phobic stimuli on fear reduction. Cognitive Therapy and Research 1978, 2(1):11-24. 10.1007/BF01172509.
61. Harris A.J. An experiment on affective contrast. American Journal of Psychology 1929, 41(4):617-624. 10.2307/1414718.
62. Hayes S.C., Wilson K.G., Gifford E.V., Follette V.M., Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology 1996, 64(6):1152-1168. 10.1037/0022-006x.64.6.1152.
63. Hazlett-Stevens H., Borkovec T.D. Effects of worry and progressive relaxation on the reduction of fear in speech phobia: An investigation of situational exposure. Behavior Therapy 2001, 32(3):503-517. 10.1016/S0005-7894(01)80033-2.
64. Heide F.J., Borkovec T.D. Relaxation-induced anxiety: Paradoxical anxiety enhancement due to relaxation training. Journal of Consulting and Clinical Psychology 1983, 51(2):171-182. 10.1037/0022-006X.51.2.171.
65. Heide F.J., Borkovec T.D. Relaxation-induced anxiety: Mechanisms and theoretical implications. Behaviour Research and Therapy 1984, 22(1):1-12. 10.1016/0005-7967(84)90027-5.
66. Hoehn-Saric R., McLeod D.R., Funderburk F., Kowalski P. Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder: An ambulatory monitor study. Archives of General Psychiatry 2004, 61(9):913-921. 10.1001/archpsyc.61.9.913.
67. Hofmann S.G., Moscovitch D.A., Litz B.T., Kim H.-J., Davis L.L., Pizzagalli D.A. The worried mind: Autonomic and prefrontal activation during worrying. Emotion 2005, 5(4):464-475. 10.1037/1528-3542.5.4.464.
68. Hoyer J., Beesdo K., Gloster A.T., Runge J., Hofler M., Becker E.S. Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics 2009, 78(2):106-115. 10.1159/000201936.
69. Jones T., Davey G.C. The effects of cued UCS rehearsal on the retention of differential " fear" conditioning: An experimental analogue of the " worry" process. Behaviour Research and Therapy 1990, 28(2):159-164. 10.1016/0005-7967(90)90028-H.
70. Kessler R.C., Berglund P.A., Dewit D.J., Ustun T.B., Wang P.S., Wittchen H.U. Distinguishing generalized anxiety disorder from major depression: prevalence and impairment from current pure and comorbid disorders in the US and Ontario. International Journal of Methods in Psychiatric Research 2002, 11(3):99-111. 10.1002/mpr.128.
71. Klein M.H., Mathieu Coughlan P., Kiesler D.J. The experiencing scales. The psychotherapeutic process: A research handbook 1986, 21-71. Guilford Press, New York, NY. W.M. Pinsof, L.S. Greenberg (Eds.).
72. Klein M.H., Mathieu P.C., Gendlin E.T., Kiesler D.J. The Experiencing Scale: A research and training manual (Vol.1) 1969, University of Wisconsin Extension Bureau of Audiovisual Instruction, Madison, WI.
73. Knepp M.M., Friedman B.H. Cardiovascular activity during laboratory tasks in women with high and low worry. Biological Psychology 2008, 79(3):287-293. 10.1016/j.biopsycho.2008.07.002.
74. Kuehner C., Huffziger S., Liebsch K. Rumination, distraction and mindful self-focus: Effects on mood, dysfunctional attitudes and cortisol stress response. Psychological Medicine 2009, 39(02):219-228. 10.1017/S0033291708003553.
75. Llera S.J., Newman M.G. Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants. Emotion 2010, 10(5):640-650. doi:10.1037/a0019351.
76. Llera, S. J., & Newman, M. G. (2010b, November). Revisiting emotional avoidance in GAD. Paper presented at the Association of Behavioral and Cognitive Therapies.
77. Lyonfields J.D., Borkovec T.D., Thayer J.F. Vagal tone in generalized anxiety disorder and the effects of aversive imagery and worrisome thinking. Behavior Therapy 1995, 26(3):457-466. 10.1016/S0005-7894(05)80094-2.
78. Manstead A.S., Wagner H.L., MacDonald C.J. A contrast effect in judgments of own emotional state. Motivation and Emotion 1983, 7(3):279-290. 10.1007/bf00991678.
79. Marks I., Lovell K., Noshirvani H., Livanou M., Thrasher S. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry 1998, 55(4):317-325. 10.1001/archpsyc.55.4.317.
80. Mathews A., MacLeod C. Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology 2005, 1(1):167-195. 10.1146/annurev.clinpsy.1.102803.143916.
81. Mavissakalian M., Michelson L. Agoraphobia: Relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine. Journal of Clinical Psychiatry 1986, 47(3):117-122.
82. McKay D. Exposure and ritual prevention reduces symptoms more than stress management training in OCD treated with SSRIs. Evidence-Based Mental Health 2009, 12(1):17. 10.1136/ebmh.12.1.17.
83. Mennin D.S. Emotion regulation therapy: An integrative approach to treatment-resistant anxiety disorders. Journal of Contemporary Psychotherapy 2006, 36(2):95-105. 10.1007/s10879-006-9012-2.
84. Mennin D.S., Heimberg R.G., Turk C.L., Fresco D.M. Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice 2002, 9(1):85-90. 10.1093/clipsy/9.1.85.
85. Mennin D.S., Heimberg R.G., Turk C.L., Fresco D.M. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy 2005, 43(10):1281-1310. 10.1016/j.brat.2004.08.008.
86. Mersch P.P.A. The treatment of social phobia: The differential effectiveness of exposure in vivo and an integration of exposure in vivo, rational emotive therapy and social skills training. Behaviour Research and Therapy 1995, 33(3):259-269. 10.1016/0005-7967(94)00038-L.
87. Metzger R.L., Miller M.L., Cohen M., Sofka M., Borkovec T.D. Worry changes decision making: The effect of negative thoughts on cognitive processing. Journal of Clinical Psychology 1990, 46(1):78-88. 10.1002/1097-4679(199001)46:1<78::AID-JCLP2270460113>3.0.CO;2-R.
88. Meyer T.J., Miller M.L., Metzger R.L., Borkovec T.D. Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 1990, 28(6):487-495. 10.1016/0005-7967(90)90135-6.
89. Moberly N.J., Watkins E.R. Ruminative self-focus, negative life events, and negative affect. Behaviour Research and Therapy 2008, 46(9):1034-1039. 10.1016/j.brat.2008.06.004.
90. Moberly N.J., Watkins E.R. Ruminative self-focus and negative affect: An experience sampling study. Journal of Abnormal Psychology 2008, 117(2):314-323. 10.1037/0021-843X.117.2.314.
91. Mogg K., Millar N., Bradley B.P. Biases in eye movements to threatening facial expressions in generalized anxiety disorder and depressive disorder. Journal of Abnormal Psychology 2000, 109(4):695-704. 10.1037//0021-843X.109.4.695.
92. Newman M.G., Castonguay L.G., Borkovec T.D., Fisher A.J., Nordberg S.S. An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training 2008, 45(2):135-147. 10.1037/0033-3204.45.2.135.
93. Newman M.G., Castonguay L.G., Borkovec T.D., Molnar C. Integrative psychotherapy. Generalized anxiety disorder: Advances in research and practice 2004, 320-350. Guilford Press, New York, NY. R.G. Heimberg, C.L. Turk, D.S. Mennin (Eds.).
94. Newman M.G., Erickson T.M. Generalized anxiety disorder. Interpersonal processes in the anxiety disorders: Implications for understanding psychopathology and treatment 2010, 235-259. American Psychological Association, Washington, DC. J.G. Beck (Ed.).
95. Newman M.G., Hofmann S.G., Trabert W., Roth W.T., Taylor C.B. Does behavioral treatment of social phobia lead to cognitive changes?. Behavior Therapy 1994, 25(3):503-517. 10.1016/S0005-7894(05)80160-1.
96. Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J., Szkodny, L et al. (in press). A randomized controlled trial of cognitive-behavioral therapy with integrated techniques from emotion-focused and interpersonal therapies. Journal of Consulting and Clinical Psychology.
97. Oathes D.J., Ray W.J., Yamasaki A.S., Borkovec T.D., Castonguay L.G., Newman M.G., et al. Worry, generalized anxiety disorder, and emotion: Evidence from the EEG gamma band. Biological Psychology 2008, 79(2):165-170. 10.1016/j.biopsycho.2008.04.005.
98. öst L.G., Alm T., Brandberg M., Breitholtz E. One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behaviour Research and Therapy 2001, 39(2):167-183. 10.1016/S0005-7967(99)00176-X.
99. öst L.G., Salkovskis P.M., HËllstrom K. One session therapist-directed exposure vs. self-exposure in the treatment of spider phobia. Behavior Therapy 1991, 22(3):407-422. 10.1016/S0005-7894(05)80374-0.
100. Peasley-Miklus C., Vrana S.R. Effect of worrisome and relaxing thinking on fearful emotional processing. Behaviour Research and Therapy 2000, 38(2):129-144. 10.1016/S0005-7967(99)00025-X.
101. Pieper S., Brosschot J.F. Prolonged stress-related cardiovascular activation: Is there any?. Annals of Behavioral Medicine 2005, 30(2):91-103. 10.1207/s15324796abm3002_1.
102. Pieper S., Brosschot J.F., van der Leeden R., Thayer J.F. Cardiac effects of momentary assessed worry episodes and stressful events. Psychosomatic Medicine 2007, 69(9):901-909. 10.1097/PSY.0b013e31815a9230.
103. Pieper S., Brosschot J.F., van der Leeden R., Thayer J.F. Prolonged cardiac effects of momentary assessed stressful events and worry episodes. Psychosomatic Medicine 2010, 72(6):570-577. doi: 10.1097/PSY.0b013e3181dbc0e9.
104. Rachman S. Emotional processing. Behaviour Research and Therapy 1980, 18(1):51-60. 10.1016/0005-7967(80)90069-8.
105. Roemer L., Orsillo S.M. Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice 2002, 9(1):54-68. 10.1093/clipsy/9.1.54.
106. Roemer L., Orsillo S.M., Salters-Pedneault K. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology 2008, 76(6):1083-1089. 10.1037/a0012720.
107. Roemer L., Salters K., Raffa S.D., Orsillo S.M. Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research 2005, 29(1):71-88. 10.1007/s10608-005-1650-2.
108. Roger D., Jamieson J. Individual differences in delayed heart-rate recovery following stress: The role of extraversion, neuroticism and emotional control. Personality and Individual Differences 1988, 9(4):721-726. 10.1016/0191-8869(88)90061-x.
109. Ruscio A.M., Borkovec T.D. Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy 2004, 42(12):1469-1482. 10.1016/j.brat.2003.10.007.
110. Scheier M.F., Bridges M.W. Person variables and health: Personality predispositions and acute psychological states as shared determinants for disease. Psychosomatic Medicine 1995, 57(3):255-268.
111. Schlotz W., Hellhammer J., Schulz P., Stone A.A. Perceived work overload and chronic worrying predict weekend-weekday differences in the cortisol awakening response. Psychosomatic Medicine 2004, 66(2):207-214. 10.1097/01.psy.0000116715.78238.56.
112. Segerstrom S.C., Glover D.A., Craske M.G., Fahey J.L. Worry affects the immune response to phobic fear. Brain, Behavior, and Immunity 1999, 13(2):80-92. 10.1006/brbi.1998.0544.
113. Segerstrom S.C., Solomon G.F., Kemeny M.E., Fahey J.L. Relationship of worry to immune sequelae of the Northridge earthquake. Journal of Behavioral Medicine 1998, 21(5):433-450. 10.1023/A:1018732309353.
114. Segerstrom S.C., Tsao J.C.I., Alden L.E., Craske M.G. Worry and rumination: Repetitive thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research 2000, 24(6):671-688. 10.1023/A:1005587311498.
115. Stapinski L.A., Abbott M.J., Rapee R.M. Evaluating the cognitive avoidance model of generalised anxiety disorder: Impact of worry on threat appraisal, perceived control and anxious arousal. Behaviour Research and Therapy 2010, 48(10):1032-1040. 10.1016/j.brat.2010.07.005.
116. Startup H.M., Davey G.C.L. Mood as input and catatrophic worrying. Journal of Abnormal Psychology 2001, 110(1):83-96. 10.1037//0021-843X.110.1.83.
117. Suchday S., Carter M.M., Ewart C.K., Larkin K.T., Desiderato O. Anger cognitions and cardiovascular recovery following provocation. Journal of Behavioral Medicine 2004, 27(4):319-341. 10.1023/B:JOBM.0000042408.80551.e1.
118. Tallis F., Eysenck M., Mathews A. Elevated evidence requirements and worry. Personality and Individual Differences 1991, 12(1):21-27. 10.1016/0191-8869(91)90128-X.
119. Thayer S. The effect of expression sequence and expressor identity on judgments of the intensity of facial expression. Journal of Nonverbal Behavior 1980, 5(2):71-79. 10.1007/bf00986510.
120. Thayer J.F., Friedman B.H., Borkovec T.D. Autonomic characteristics of generalized anxiety disorder and worry. Biological Psychiatry 1996, 39(4):255-266. 10.1016/0006-3223(95)00136-0.
121. Turk C.L., Heimberg R.G., Luterek J.A., Mennin D.S., Fresco D.M. Emotion dysregulation in generalized anxiety disorder: A comparison with social anxiety disorder. Cognitive Therapy and Research 2005, 5(1):89-106. 10.1007/s10608-005-1651-1.
122. Vasey M.W., Borkovec T.D. A catastrophizing assessment of worrisome thoughts. Cognitive Therapy and Research 1992, 16(5):505-520. 10.1007/BF01175138.
123. Verkuil B., Brosschot J.F., de Beurs D.P., Thayer J.F. Effects of explicit and implicit perseverative cognition on cardiac recovery after cognitive stress. International Journal of Psychophysiology 2009, 74(3):220-228. 10.1016/j.ijpsycho.2009.09.003.
124. Vickers K.S., Vogeltanz-Holm N.D. The Effects of Rumination and Distraction Tasks on Psychophysiological Responses and Mood in Dysphoric and Nondysphoric Individuals. Cognitive Therapy and Research 2003, 27(3):331-348. 10.1023/a:1023970501448.
125. Vrana S.R., Cuthbert B.N., Lang P.J. Fear imagery and text processing. Psychophysiology 1986, 23(3):247-253. 10.1111/j.1469-8986.1986.tb00626.x.
126. Vrana S.R., Cuthbert B.N., Lang P.J. Processing fearful and neutral sentences: Memory and heart rate change. Cognition and Emotion 1989, 3(3):179-195.
127. Vrana S.R., Lang P.J. Fear imagery and the startle-probe reflex. Journal of Abnormal Psychology 1990, 99(2):189-197. 10.1037/0021-843X.99.2.189.
128. Waters A.M., Mogg K., Bradley B.P., Pine D.S. Attentional bias for emotional faces in children with generalized anxiety disorder. Journal of the American Academy of Child and Adolescent Psychiatry 2008, 47(4):435-442. 10.1097/CHI.0b013e3181642992.
129. Wegner D.M., Schneider D.J., Carter S.R., White T.L. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology 1987, 53(1):5-13. 10.1037/0022-3514.53.1.5.
130. Wells A. Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy 1995, 23(3):301-320. 10.1017/S1352465800015836.
131. Wells A. A metacognitive model and therapy for generalized anxiety disorder. Clinical Psychology and Psychotherapy 1999, 6(2):86-95. 10.1002/(SICI)1099-0879(199905)6:2<71::AID-CPP186>3.0.CO;2-G.
132. Wells A. A Cognitive Model of GAD: Metacognitions and Pathological Worry. Generalized anxiety disorder: Advances in research and practice 2004, 2164-2186. Guilford Press, New York, NY, US, (xvi, 2446). R.G. Heimberg, C.L. Turk, D.S. Mennin (Eds.).
133. Wells A., Papageorgiou C. Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy 1995, 33(5):579-583. 10.1016/0005-7967(94)00087-Z.
134. Westen D., Morrison K. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology 2001, 69(6):875-899. 10.1037//0022-006X.69.6.875.
135. Williams G.D. The effect of order of appearance on the appreciation of musical selections. Journal of General Psychology 1942, 27:295-310.
136. Wilson E.J., MacLeod C., Mathews A., Rutherford E.M. The causal role of interpretive bias in anxiety reactivity. Journal of Abnormal Psychology 2006, 115(1):103-111. 10.1037/0021-843X.115.1.103.
137. York D., Borkovec T.D., Vasey M., Stern R. Effects of worry and somatic anxiety induction on thoughts, emotion and physiological activity. Behaviour Research and Therapy 1987, 25(6):523-526. 10.1016/0005-7967(87)90060-X.
138. Zinbarg R.E., Lee J.E., Yoon K.L. Dyadic predictors of outcome in a cognitive-behavioral program for patients with generalized anxiety disorder in committed relationships: A " spoonful of sugar" and a dose of non-hostile criticism may help. Behaviour Research and Therapy 2007, 45(4):699-713. 10.1016/j.brat.2006.06.005.