Applying an Emotion Regulation Framework to Integrative Approaches to Generalized Anxiety Disorder

Great strides have been made in the conceptualization and treatment of anxiety disorders in the past two decades. However, fewer studies of generalized anxiety disorder (GAD) were published between 1980 and 1997 than studies of panic disorder, obsessive-compulsive disorder, or post-traumatic stress disorder (Dugas, 2000). Nevertheless, efforts to understand and treat GAD have increased substantially in recent years. Cognitive-behavioral approaches have been fruitful with respect to understanding and treating GAD. However, the proportion of clients who are not helped by these treatments or who experience significant residual symptoms is larger than for other anxiety disorders (Brown, Barlow, & Liebowitz, 1994; Gould, Safren, O’Neill Washington, & Otto, in press). Cognitive-behavioral theorists and practitioners must broaden their conceptualization of GAD and consider importing techniques from other psychotherapeutic approaches to increase the likelihood that clients with GAD will have an adequate response to treatment. Indeed, Roemer and Orsillo (this issue; see also Newman, Castonguay, Borkovec, & Molnar, in press) expand the boundaries of cognitivebehavioral approaches to GAD, supplementing cognitivebehavioral treatments with compatible experiential techniques. The integrative approach of Roemer and Orsillo (this issue) begins with Borkovec’s avoidance model of worry (for a review, see Borkovec, Alcaine, & Behar, in press). Borkovec and colleagues argue that worry allows individuals to process emotional topics at an abstract, conceptual level and, consequently, avoid aversive images, autonomic arousal, and intense negative emotions in the short run. In this way, worry is negatively reinforced. Although worry allows individuals to deal with emotional material at an abstract, conceptual level, it does not allow the individual to quiet emotional distress and put it aside. Therefore, over the long term, the individual is continuously confronted with troubling emotional material, has a more intense experience of anxiety, and repeatedly engages in frequent worry to dull this experience. Roemer and Orsillo (this issue) logically connect Borkovec’s conceptualization of GAD to the work of Hayes and colleagues, who have focused on experiential avoidance which “occurs when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral dispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them” (Hayes, Strosahl, &Wilson, 1999, p. 58). Evidence is emerging to show that experiential avoidance is associated with many psychological disorders and that acceptance-based treatments intended to reduce experiential avoidance are effective in helping individuals overcome these difficulties (Hayes et al., 1999). Roemer and Orsillo present a compelling approach to the treatment of GAD, which combines cognitive-behavioral therapy with acceptance-based and mindfulness techniques. At its highest level, accep-