Hostname: page-component-7f64f4797f-7vqc4 Total loading time: 0 Render date: 2025-11-04T09:40:22.113Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive-Behavioral Therapy for Generalized Anxiety Disorder With Integrations From Interpersonal and Experiential Therapies

Published online by Cambridge University Press:  07 November 2014

Thomas D. Borkovec ,
Michelle G. Newman  and
Louis G. Castonguay
Get access Rights & Permissions [Opens in a new window]

Abstract

After providing background information on the definition and nature of generalized anxiety disorder, this article describes cognitive-behavioral therapy (CBT) methods that have been empirically supported in the treatment of this disorder. Subsequent to this description, relevant outcome literature is briefly reviewed, along with evidence that the addition of other techniques beyond traditional CBT methods may be necessary to maximize clinical outcome. A description is then provided of an integrated interpersonal/emotional processing therapy that the authors have recently added to their CBT protocol. CBT with and without this integrated treatment is currently being evaluated in an experimental trial.

Information

Type
Review
Information
CNS Spectrums , Volume 8 , Issue 5: Psychosocial Treatment of Anxiety Disorders , May 2003 , pp. 382 - 389
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.Google Scholar
2.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
3.Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ. Generalized anxiety disorder in women. A population-based twin study. Arch Gen Psychiatry. 1992;49:267–272.CrossRefGoogle ScholarPubMed
4.Wittchen, HU, Zhao, S, Kessler, RC, Eaton, WW. DSM-III-R generalized anxiety disorder in the national comorbidity survey. Arch Gen Psychiatry. 1994;51:355–364.CrossRefGoogle ScholarPubMed
5.Brown, TA, Barlow, DH. Comorbidity among anxiety disorders: implications for treatment and DSM-IV. J Consult Clin Psychol. 1992;60:835–844.CrossRefGoogle ScholarPubMed
6.Greenberg, PE, Sisitsky, T, Kessler, RC, et al.The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60:427–435.CrossRefGoogle ScholarPubMed
7.Bland, RC, Newman, SC, Orn, H. Help-seeking for psychiatric disorders. Can J Psychiatry. 1997;42:935–942.CrossRefGoogle ScholarPubMed
8.Kennedy, BL, Schwab, JJ. Utilization of medical specialists by anxiety disorder patients. Psychosomatics. 1997;38:109–112.CrossRefGoogle ScholarPubMed
9.Kessler, RC. The epidemiology of pure and comorbid generalized anxiety disorder: A review and evaluation of recent research. Acta Psychiatr Scand. 2000;102(suppl 406):7–13.CrossRefGoogle Scholar
10.MacLeod, C. Information processing approaches to generalized anxiety disorder: assessing the selective functioning of attention, interpretation, and memory in GAD patients. In: Heimberg, RG, Turk, CL, Mennin, DS, eds. Generalized Anxiety Disorder: Advances in Research and Practice. New York, NY: Guilford Press. In press.Google Scholar
11.Carter, WR, Johnson, MC, Borkovec, TD. Worry: an electrocortical analysis. Behav Res Ther. 1986;8:193–204.CrossRefGoogle Scholar
12.Ray, WJ, Oathes, D, Yamasaki, A, et al. Generalized anxiety disorder clients show normalized EEG patterns after psychotherapy. Paper presented at: Annual Meeting of the Society for Psychophysiological Reserarch; October 12-14, 2000; San Diego, Calif.Google Scholar
13.Oathes, DJ, Yamasaki, AS, Ray, WJ, Borkovec, TD. EEG measures in generalized anxiety disorder before and after psychotherapy. Paper presented at: Annual Meeting of the Society for Research in Psychopathology; November 15-17, 2001; Madison, Wis.Google Scholar
14.Hoehn-Saric, R, McLeod, DR. The peripheral sympathetic nervous system. Its role in normal and pathological anxiety. Psychiatr Clin North Am. 1988;11:375–386.CrossRefGoogle Scholar
15.Hoehn-Saric, R, McLeod, DR, Zimmerli, WD. Somatic manifestations in women with generalized anxiety disorder. Physiological responses to psychological stress. Arch Gen Psychiatry. 1989;46:1113–1119.CrossRefGoogle ScholarPubMed
16.Thayer, JF, Friedman, BH, Borkovec, TD. Autonomic characteristics of generalized anxiety disorder and worry. Biol Psychiatry. 1996;39:255–266.CrossRefGoogle ScholarPubMed
17.Borkovec, TD, Hu, S. The effect of worry on cardiovascular response to phobic imagery. Behav Res Ther. 1990;28:69–73.CrossRefGoogle ScholarPubMed
18.Borkovec, TD, Lyonfields, JD, Wiser, SL, Diehl, L. The role of worrisome thinking in the suppression of cardiovascular response to phobic imagery. Behav Res Ther. 1993;31:321–4.CrossRefGoogle ScholarPubMed
19.Foa, EB, Kozak, MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99:20–35.CrossRefGoogle ScholarPubMed
20.Borkovec, TD, Alcaine, O, Behar, E. Avoidance theory of worry and generalized anxiety disorder. In: Heimberg, RG, Turk, CL, Mennin, DS, eds. Generalized Anxiety Disorder: Advances in Research and Practice. New York, NY: Guilford Press. In press.Google Scholar
21.Jacobson, E. Progressive Relaxation. Chicago, Ill: University of Chicago Press; 1938.Google Scholar
22.Ost, L. Applied relaxation: description of a coping technique and review of controlled studies. Behav Res Ther. 1987;25:397–409.CrossRefGoogle ScholarPubMed
23.Bernstein, DA, Borkovec, TD, Hazlett-Stevens, H. New Directions in Progressive Relaxation Training: A Guidebook for Helping Professionals. Westport, Conn: Praeger Publishers; 2000.Google Scholar
24.Beck, AT, Emery, G. Anxiety Disorders and Phobias: A Cognitive Perspective. New York, NY: Basic Books; 1985.Google Scholar
25.Borkovec, TD, Sharpless, B. Cognitive-behavioral therapy for generalized anxiety disorder: living in the valued present. In: Hayes, S, Linehan, M, Folette, V, eds. Mindfulness, Acceptance, and the New Behavior Therapies: Expanding the Cognitive-Behavioral Tradition. New York, NY: Guilford Press. In press.Google Scholar
26.Suinn, RM, Richardson, F. Anxiety management training: a nonspecific behavior therapy program for anxiety control. Behav Res Ther. 1971;2:498–510.CrossRefGoogle Scholar
27.Goldfried, MR. Systematic desensitization as training in self-control. J Consult Clin Psychol. 1971;37:228–234.CrossRefGoogle ScholarPubMed
28.Garry, M, Manning, CG, Loftus, EF, Sherman, SJ. Imagination inflation: imagining a childhood event inflates confidence that it occurred. Psychol Bull Rev. 1996;3:208–214.CrossRefGoogle ScholarPubMed
29.Butler, B, Cullington, A, Hibbert, G, et al.Anxiety management for persistent generalized anxiety. Br J Psychiatry. 1987;151:535–542.CrossRefGoogle Scholar
30.Borkovec, TD, Wilkinson, L, Folensbee, R, Lerman, C. Stimulus control applications to the treatment of worry. Behav Res Ther. 1983;21:247–251.CrossRefGoogle Scholar
31.Ladouceur, R, Dugas, MJ, Freeston, MH, Leger, E, Gagnon, F, Thibodeau, N. Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. J Consult Clin Psychol. 2000;68:957–964.CrossRefGoogle Scholar
32.Barlow, DH, Cohen, AS, Waddell, M, et al.Panic and generalized anxiety disorders: nature and treatment. Behav Res Ther. 1984;15:431–449.CrossRefGoogle Scholar
33.Barlow, DH, Rapee, RM, Brown, TA. Behavioral treatment of generalized anxiety disorder. Behav Res Ther. 1992;23:551–570.CrossRefGoogle Scholar
34.Borkovec, TD, Mathews, AM, Chambers, A, Ebrahami, S, Lytle, R, Nelson, R. The effects of relaxation training with cognitive therapy or nondirective therapy and the role of relaxation-induced anxiety in the treatment of generalized anxiety. J Consult Clin Psychol. 1987;25:883–888.CrossRefGoogle Scholar
35.Borkovec, TD, Mathews, AM. Treatment of nonphobic anxiety disorders: A comparison of nondirective, cognitive, and coping desensitization therapy. J Consult Clin Psychol. 1988;56:877–884.CrossRefGoogle ScholarPubMed
36.Borkovec, TD, Costello, E. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol. 1993;61:611–619.CrossRefGoogle ScholarPubMed
37.Borkovec, TD, Newman, MG, Pincus, A, Lytle, R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. J Consult Clin Psychol. 2002;70:288–298.CrossRefGoogle ScholarPubMed
38.Butler, G, Fennell, M, Robson, P, Gelder, M. Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol. 1991;59:167–175.CrossRefGoogle ScholarPubMed
39.Durham, RC, Murphy, T, Allan, T, Richard, K, Treliving, LR, Fenton, GW. Cognitive therapy, analytic psychotherapy and anxiety management for generalised anxiety disorder. Br J Psychiatry. 1994;165:315–323.CrossRefGoogle ScholarPubMed
40.Ost, LG, Breitholtz, E. Applied relaxation versus cognitive therapy in the treatment of generalized anxiety disorder. Behav Res Ther. 2000;38:777–790.CrossRefGoogle Scholar
41.Power, KG, Jerrom, DW, Simpson, RJ, et al.A controlled comparison of cognitive behavior therapy, diazepam and placebo in the management of generalized anxiety. Behavioural Psychother. 1989;17:1–14.CrossRefGoogle Scholar
42.Power, KG, Simpson, MB, Swanson, V, et al.A controlled comparison of cognitivebehavior therapy, diazepam, and placebo, alone and in combination, for the treatment of generalized anxiety disorder. J Anxiety Disord. 1990;4:269–292.CrossRefGoogle Scholar
43.Blowers, C, Cobb, J, Mathews, AM. Generalized anxiety: a controlled treatment study. Behav Res Ther. 1987;25:493–502.CrossRefGoogle ScholarPubMed
44.Stanley, MA, Beck, JG, Glassco, JD. Treatment of generalized anxiety disorder in older adults: a preliminary comparison of cognitive-behavioral and supportive approaches. Behav Res Ther. 1996;27:565–581.CrossRefGoogle Scholar
45.White, J, Keenan, M, Brooks, N. Stress control: a controlled comparative investigation of large group therapy for generalized anxiety disorder. Behavioural Psychother. 1992;20:97–114.CrossRefGoogle Scholar
46.Chambless, DL, Ollendick, TH. Empirically supported psychological interventions: controversies and evidence. Annu Rev Psychol. 2001;52:685–716.CrossRefGoogle ScholarPubMed
47.Borkovec, TD, Ruscio, AM. Psychotherapy for generalized anxiety disorder. J Clin Psychiatry. 2001;62:37–45.Google ScholarPubMed
48.Hamilton, M. The measurement of anxiety states by rating. Br J Med Psychol. 1959;32:50–55.CrossRefGoogle Scholar
49.Brown, TA, DiNardo, PA, Barlow, DH. Anxiety Disorders Interview Schedule for DSM-IV. Albany, NY: Graywood Publications; 1994.Google Scholar
50.Spielberger, CD, Gorsuch, RL, Lushene, R, et al.Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, Calif: Consulting Psychologists Press; 1983.Google Scholar
51.Borkovec, TD, Abel, JL, Newman, H. The effects of therapy on comorbid conditions in generalized anxiety disorder. J Consult Clin Psychol. 1995;63:479–483.CrossRefGoogle Scholar
52.Borkovec, TD, Whisman, MA. Psychological treatment for generalized anxiety disorder. In: Mavissakalian, MR, Prien, RF, eds. Long-Term Treatments of Anxiety Disorders. Washington, DC: American Psychiatric Association; 1996.Google Scholar
53.Brown, TA, Barlow, DH, Liebowitz, MR. The empirical basis of generalized anxiety disorder. Am J Psychiatry. 1994;151:1272–1280.Google ScholarPubMed
54.Sanderson, WC, Wetzler, S, Beck, AT, Betz, F. Prevalence of personality disorders among patients with anxiety disorders. Psychiatry Res. 1994;51:167–174.CrossRefGoogle ScholarPubMed
55.Barlow, DH, DiNardo, PA, Vermilea, BB, Vermilyea, J, Blanchard, EB. Comorbidity and depression among the anxiety disorders: issues in diagnosis and classification. J Nerv Ment Dis. 1986;174:63–72.CrossRefGoogle ScholarPubMed
56.Roemer, L, Molina, S, Borkovec, TD. An investigation of worry content among generally anxious individuals. J New Ment Dis. 1997;185:314–319.CrossRefGoogle ScholarPubMed
57.Whisman, MA, Sheldon, CT, Goering, P. Psychiatric disorders and dissatisfaction with social relationships: does type of relationship matter? J Abnorm Psychol. 2000;109:803–808.CrossRefGoogle ScholarPubMed
58.Alden, LE, Wiggins, JS, Pincus, AL. Construction of circumplex scales for the Inventory of Interpersonal Problems. J Pers Assess. 1990;55:521–536.CrossRefGoogle ScholarPubMed
59.Horowitz, LM, Rosenberg, SE, Bauer, BA, Ureno, G, Vilasenor, VS. Inventory of Interpersonal Problems: psychometric properties and clinical applications. J Consult Clin Psychol. 1988;56:885–892.CrossRefGoogle ScholarPubMed
60.Borkovec, TD, Newman, MG, Pincus, AL, Lytle, R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. J Consult Clin Psychol. 2002;70:288–298.CrossRefGoogle ScholarPubMed
61.Robins, CJ, Hayes, AM. An appraisal of cognitive therapy. J Consult Clin Psychol. 1993;61:205–214.CrossRefGoogle ScholarPubMed
62.Castonguay, LG, Hayes, AM, Goldfried, MR, DeRubeis, RJ. The focus of therapist interventions in cognitive therapy for depression. Cognitive Ther Res. 1995;19:487–505.CrossRefGoogle Scholar
63.Hayes, AH, Castonguay, LG, Goldfried, MR. The effectiveness of targeting the vulnerability factors of depression in cognitive therapy. J Consult Clin Psychol. 1996;64:623–627.CrossRefGoogle ScholarPubMed
64.Kerr, S, Goldfried, MR, Hayes, AM, Castonguay, LG, Goldsamt, LA. Interpersonal and intrapersonal focus in cognitive-behavioral and psychodynamic-interpersonal therapies: a preliminary analysis of the Sheffield project. Psychother Res. 1992;2:266–276.CrossRefGoogle Scholar
65.Castonguay, LG, Hayes, AM, Goldfried, MR, Drozd, J, Schut, AJ, Shapiro, DA. Intrapersonal and interpersonal focus in psychodynamic-interpersonal and cognitive-behavioral therapies: a replication and extension. Paper presented at: Annual Meeting of the Society for Psychotherapy Research; June 24-26, 1998; Snowbird, Utah.Google Scholar
66.Jones, EE, Pulos, SM. Comparing the process in psychodynamic and cognitivebehavioral therapies. J Consult Clin Psychol. 1993;61:306–316.CrossRefGoogle ScholarPubMed
67.Durham, RC, Allan, T, Hackett, CA. On predicting improvement and relapse in generalized anxiety disorder following psychotherapy. Br J Clin Psychol. 1997;36:101–119.CrossRefGoogle ScholarPubMed
68.Sanderson, WC, Beck, AT, McGinn, LK. Cognitive therapy for generalized anxiety disorder significance of comorbid personality disorders. J Cognitive Psychother. 1994;8:13–18.CrossRefGoogle Scholar
69.Newman, MG, Castonguay, LG, Borkovec, TD, Molnar, C. Integrative psychotherapy for generalized anxiety disorder. In: Turk, C, ed. The Nature and Treatment of Generalized Anxiety Disorder: New York, NY: Guilford Press. In press.Google Scholar
70.Castonguay, LG, Schut, AJ, Aikins, D, et al.Integrative cognitive therapy: a preliminary investigation. J Psychother Integration. In press.Google Scholar
71.Safran, JD, Muran, JC, Samstag, LW. Resolving therapeutic alliance ruptures: a task analytic investigation. In: Horvath, AO, Greenberg, LS, eds. The Working Alliance: Theory, Research, and Practice. Oxford, England: John Wiley & Sons; 1994:225–255.Google Scholar
72.Borkovec, TD, Roemer, L. Perceived functions of worry among generalized anxiety disorder subjects: distraction from more emotionally distressing topics? J Behav Ther Exp Psychiatry. 1995;26:25–30.CrossRefGoogle ScholarPubMed
73.Abel, JL. Alexithymia in an analogue sample of generalized anxiety disorder and non-anxious matched controls. Paper presented at: Annual Meeting of the Association for the Advancement of Behavior Therapy; November 13-16, 1994; San Diego, Calif.Google Scholar
74.Mahoney, MJ. Psychotherapy and the structure of personal revolutions. In: Mahoney, MJ, ed. Psychotherapy Process: Current Issues and Future Directions. New York, NY: Plenum Press; 1980:157–180.CrossRefGoogle Scholar
75.Messer, SB. Behavior and psychoanalytic perspectives at therapeutic choice points. Am Psychol. 1986;41:1261–1272.CrossRefGoogle ScholarPubMed
76.Wiser, S, Goldfried, MR. Comparative study of emotional experiencing in psychodynamic-interpersonal and cognitive-behavioral therapies. J Consult Clin Psychol. 1993;61:892–895.CrossRefGoogle ScholarPubMed
77.Castonguay, LG, Goldfried, MR, Wiser, S, Raue, PJ, Hayes, AM. Predicting outcome in cognitive therapy for depression: a comparison of unique and common factors. J Consult Clin Psychol. 1996;64:497–504.CrossRefGoogle Scholar
78.Castonguay, LG, Pincus, AL, Agras, WS, Hines, CE. The role of emotion in group cognitive-behavioral therapy for binge eating disorder: when things have to feel worst before they get better. Psychother Res. 1998;8:225–238.CrossRefGoogle Scholar
79.Greenberg, LS, Rice, LN, Elliott, R. Facilitating Emotional Change: The Moment-by-Moment Process. New York, NY: Guilford Press; 1993.Google Scholar
80.Newman, MG, Castonguay, LG, Borkovec, TD, Schut, AJ. Integrating cognitivebehavioral, interpersonal, and humanistic interventions: why should we and how can we? Paper presented at: First Mid-Atlantic Chapter Meeting of the Society for Psychotherapy Research; November 1999; College Park, Md.Google Scholar
81.Borkovec, TD, Castonguay, LG. What is the scientific meaning of empirically supported therapy? J Consult Clin Psychol. 1998;66:136–142.CrossRefGoogle ScholarPubMed
82.Newman, MG, Castonguay, LG, Borkovec, TD. Integrating cognitive-behavioral and interpersonal/emotional processing treatments for generalized anxiety disorder: preliminary outcome findings. Paper presented at: Annual Meeting of The Society for Psychotherapy Research; June 19-21, 2002; Santa Barbara, Calif.Google Scholar