Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania 16802-3106, USA.
Annu Rev Clin Psychol. 2013;9:275-97. doi: 10.1146/annurev-clinpsy-050212-185544.
Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.
广泛性焦虑障碍（GAD）与巨大的个人和社会成本相关，但却是焦虑障碍中治疗效果最差的一种。在这篇综述中，我们介绍了临床特征、边界问题和自然病程，以及风险因素和维持机制（认知、生物、神经、人际和发展）的研究。这些数据的综合表明，情绪过度反应、对相反情绪的敏感以及通过担忧来应对强烈情绪变化的功能失调尝试在其中起着核心作用。与对比回避模型一致，有证据表明担忧会引起和维持负面情绪，从而阻止负面情绪的急剧增加。我们还回顾了当前的治疗模式，并提出了对比回避模型如何帮助针对广泛性焦虑障碍中维持病理的关键恐惧和回避倾向。
