394 TREATMENT OF SPECIFIC ANXIETY DISORDERS
abnormal worry (Ruscio et al., 2001). One solution might be to reserve the term “worry”
for the maladaptive forms of repetitive thought associated with heightened anxiety or
distress and which serve no particular adaptability for dealing with anticipated future
danger. The core distinguishing element of pathological worry is an exaggerated antici-
pation of future negative outcomes (i.e., “that something bad might happen”). On the
other hand, adaptive worry is more constructive, task- oriented repetitive thought that
acts as preparatory coping or a problem- solving activity (Mathews, 1990).
The Function of Worry
One of the consequences of worry is its ability to generate and maintain anxiety in
the absence of an external threat by perpetutating thoughts and images of nonexistent
threats and dangers anticipated in the future (Borkovec, 1985). In this way worry is a
contributor in the etiology and maintenance of anxiety. Most clinical researchers now
consider worry a maladaptive cognitive avoidant coping strategy. Mathews (1990) sug-
gests that worry contributes to the persistence of heightened anxiety by maintaining
high levels of vigilance for personal danger. M. W. Eysenck (1992) proposed that worry
has three functions: (1) alarm— introduces threat cues into conscious awareness, (2)
prompt— repeatedly represents threat- related thought and images into consciousness,
and (3) preparation— permits the worrier to anticipate a future situation by generat-
ing a solution to the problem or emotional preparation for the negative consequences.
He argued that worry can be constructive (i.e., leading to problem resolution) or it can
become excessive and maladaptive if the perceived threat is considered highly probable,
imminent, aversive, and unmanageable (i.e., perceived limited access to postevent cop-
ing strategies). There is a self- perpetuating quality to worry because its functions as a
negative reinforcer by creating the illusion of certainty, predictability, and control of
anticipated threat or danger (Barlow, 2002).
Borkovec has developed the most extensive conceptualization of worry as a mal-
adaptive cognitive avoidance response to future threat (Roemer & Borkovec, 1993).
Worry is a predominantly conceptual, verbal– linguistic process that is self- perpetuated
via negative reinforcement through the nonoccurrence of the predicted negative outcome
or catastrophe. In addition worry is thought to suppress (inhibit) autonomic arousal and
other disturbing emotional processes (Borkovec, 1994). Worry, as an attempt to prob-
lem solve a possible future threat or danger, is therefore an effort to avoid distal dangers
(Borkovec et al., 2004). More recently Borkovec suggested that the core problem in
GAD may be fear of emotional experience in general, with worry serving as a cogni-
tive avoidance strategy for any emotional experience (Borkovec et al., 2004; Sibrava &
Borkovec, 2006).
Beck and Clark (1997) proposed that worry is an elaborative processing strat-
egy triggered by activation of automatic schematic threat processing. It is a deliberate
effort to reappraise automatic threat interpretations and establish a sense of safety in an
attempt to deactivate the hypervalent threat and vulnerability schemas that character-
ize generalized anxiety. In our cognitive model of GAD pathological worry functions
as an ironic process (i.e., Wegner, 1994) that invariably increases rather than decreases
anxiety because it magnifies the schema- congruent automatic thoughts of anticipated
negative outcomes. Clinician Guideline 10.4 provides our definition of worry and its
function in GAD.