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Psychological Causes of Generalized Anxiety Disorder

Psychological Factors
Given the fact that a tendency to worry excessively is one of the main defining features of generalized anxiety disorder, there has been a wealth of research during the past few years to better understand this phenomenon. According to Borkovec and colleagues, worry serves as a type of avoidance purpose and allows individuals to engage in excessive conceptual and semantic thinking, but avoid imagery and emotional processing. Therefore, worrying does not allow habituation, and this lack of habituation helps to maintain the anxiety experienced by people with generalized anxiety disorder. The fact that worry is largely semantic and also uses up many resources in working memory has been demonstrated by several studies. A related direction of research has focused on examining the way in which people with generalized anxiety disorder process information. In one of the earliest studies, Butler and Mathews found that generalized anxiety disorder subjects were more likely than normal controls to interpret ambiguous events as threatening.
In addition, the generalized anxiety disorder subjects believed that there was a higher likelihood that threatening events would happen to themselves, but they did not believe there was a higher likelihood that threatening events would happen to someone else. Thus, in line with suggestions by Beck, anxious individuals have a tendency to see themselves in particular danger in the world. There is also considerable evidence to suggest that persons with generalized anxiety disorder have an attentional bias toward threatening cues. In other words, potentially threatening stimuli in the environment grab the attention of persons with generalized anxiety disorder more easily and quickly than that of nonanxious people. This would suggest that such individuals are constantly scanning the environment (not necessarily consciously) for any signs of possible danger. For example, one study demonstrated that anxious subjects were faster than controls in detecting a dot on a computer screen when it was immediately preceded by a threatening word in the same part of the screen, but were slower than controls in detecting the dot when the threatening word was in a different part of the screen. For memory, the results have been somewhat less clear, and indeed it looks as though there may be little memory bias in people with generalized anxiety disorder. For example, one of the earliest tudies found a trend whereby generalized anxiety disorder subjects actually recalled fewer threatening words than normal controls. The authors suggested that once persons with generalized anxiety disorder have detected a threat, they may cognitively avoid this information, leading to decreased memory. In a later study, no significant difference in memory for threatening words was found between generalized anxiety disorder subjects and controls using a controlled memory task (i.e., one that requires attentional processes), but using a more automatic task, generalized anxiety disorder subjects did have better memory for threatening words, perhaps suggesting that the information had been extensively processed.
In summary, it seems that persons with generalized anxiety disorder (and probably all individuals who are high in trait anxiety) are characterized by a tendency to interpret ambiguous information as threatening and to pay excessive attention to potential threats. Once they detect a threat, people with generalized anxiety disorder elaborate the possibilities extensively in working memory, thereby reducing habituation. The crucial question, of course, is whether these processes are causal or are simply a consequence of anxiety. Research being conducted in several laboratories that is aimed at training people to shift their attention will help to answer this question during the coming years.

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