Psychodynamic-Interpersonal Treatment of Generalized Anxiety Disorder

Roemer and Orsillo (this issue) make a credible case for the integration of acceptance-based treatment techniques into cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). Only approximately 50% of GAD patients achieve clinically significant change with CBT (Chambless & Gillis, 1993), suggesting that additional treatment techniques need to be tested to improve response rates. The rationale for testing acceptance-based techniques rests primarily on Borkovec’s (1994) conceptualization and on emerging empirical support (Borkovec & Roemer, 1995) suggesting that worry, the central feature of GAD, is a form of avoidance, distracting individuals with GAD from more emotionally upsetting topics and/or memories. This rationale, taken together with promising preliminary results of studies of acceptancebased treatments of other patient problems (Strosahl, Hayes, Bergan, & Romano, 1998), provides a strong justification for further development and testing of the integrated package described by Roemer and Orsillo. It should be noted that acceptance of feelings is already part of the Beck and Emery (1985) treatment approach that has been the basis for the majority of the randomized clinical trials of CBT for GAD (see Beck & Emery, 1985, pp. 233–239). Presumably, the Roemer and Orsillo approach extends beyond the acceptance-oriented techniques described by Beck and Emery (1985). My colleagues and I have been developing and testing a psychodynamic-interpersonal treatment for GAD (CritsChristoph, Connolly, Azarian, Crits-Christoph, & Shappell, 1996; Crits-Christoph, Crits-Christoph, WolfPalacio, Fichter, & Rudick, 1995). In this commentary I present the background for a psychodynamic perspective on GAD, followed by a summary of our supportiveexpressive psychodynamic model and comparisons between our conceptualization and that offered by Roemer and Orsillo (this issue).