Department of Psychology, Reykjavik University, Reykjavik, Iceland.
School of Psychology and Clinical Language Science, University of Reading, Reading, UK.
Behav Cogn Psychother. 2021 Sep;49(5):526-539. doi: 10.1017/S135246582100014X. Epub 2021 Mar 12.
Generalised anxiety disorder (GAD) has been an uneasy member of the anxiety disorders group since its inclusion in the third edition of the DSM. Multiple theories and treatment protocols for GAD and its defining symptom, excessive worry, have comparable efficacy in treating GAD symptoms. Crucially, these theories of GAD and excessive worry fail to explain when and why worry is excessive and when it is adaptive.
In this paper we propose a cognitive behavioural account of the difference between excessive and adaptive states of worry and explore the theme of threat and the function of safety-seeking behaviours as seen in GAD. Specifically, we incorporate the concept of inflated responsibility in a cognitive behavioural analysis of threat appraisal and safety-seeking behaviours in excessive worry and GAD.
It is proposed that when worry is used as a strategy intended to increase safety from perceived social or physical threat then it should be conceptualised as a safety-seeking behaviour. However, when worry is used as a strategy to solve a problem which the person realistically can resolve or to deal explicitly with the feeling of anxiety then it functions as an adaptive coping behaviour. We also propose that the theme of threat in GAD centres on an inflated sense of responsibility for external everyday situations, and the function of safety-seeking behaviours is to attain certainty that responsibility has been fulfilled. The clinical implications of this cognitive behavioural analysis of excessive worry are discussed, as well as future research directions.
广泛性焦虑障碍（GAD）自从被纳入 DSM-III 以来，一直是焦虑障碍群体中的一个不稳定因素。针对 GAD 及其主要症状——过度担忧，有多种理论和治疗方案，这些理论和治疗方案在治疗 GAD 症状方面具有相当的疗效。至关重要的是，这些关于 GAD 和过度担忧的理论无法解释担忧何时过度，何时适应。
在本文中，我们提出了一种认知行为理论，解释过度担忧和适应性担忧之间的区别，并探讨了威胁的主题以及在 GAD 中寻求安全行为的功能。具体来说，我们将责任膨胀的概念纳入到对过度担忧和 GAD 中的威胁评估和寻求安全行为的认知行为分析中。
当担忧被用作一种旨在增加对感知到的社会或身体威胁的安全感的策略时，它应该被概念化为一种寻求安全的行为。然而，当担忧被用作解决一个人实际上可以解决的问题或明确处理焦虑感的策略时，它就起到了适应性应对行为的作用。我们还提出，GAD 中的威胁主题集中在对外部日常情况的责任膨胀感上，寻求安全行为的功能是获得已经履行责任的确定性。本文对过度担忧的认知行为分析的临床意义进行了讨论，并提出了未来的研究方向。
