Generalized Anxiety Disorder 399
(2002) has argued that a chronic inability to cope with unpredictable and uncontrol-
lable events is a psychological vulnerability in GAD. Behavioral inhibition is a tempera-
mental construct that has been implicated in the development of anxiety but would be
expected to have relevance for GAD (Hudson & Rapee, 2004). More recently Rapee
proposed an etiological model for GAD in which anxious vulnerability was defined in
terms of a temperament of increased emotionality, inhibition, and physiological arousal
that causes a tendency to misinterpret situations as threatening and something to avoid
(Hudson & Rapee, 2004).
Like the personality research, few studies have focused specifically on life events in
GAD. In the ECA stressful life events were associated with the onset of DSM-III GAD
(Blazer, Hughes, & George, 1987). Stressful life events were shown to correlate with
both major depression and GAD in a large community sample (Newman & Bland,
1994). Moreover, individuals are at higher risk for developing major depression when
they experience a severe life event in the presence of GAD (Hettma, Kuhn, Prescott, &
Kendler, 2006). In another study, Roemer, Molina, Litz, and Borkovec (1996–1997)
found that individuals with GAD reported significantly more potentially traumatizing
events than nonanxious individuals. Although the life event research in GAD is not
extensive, there is evidence that stressful events contribute to the onset and impact of
the disorder.
There has been some interest in whether childhood adversities might play an etio-
logical role in GAD. In one study parental psychopathology (i.e., depression, GAD,
drug/alcohol abuse), parental separation/divorce, child physical or sexual abuse, and
witnessing a trauma were associated with onset but not persistence of GAD (Kessler et
al., 1997). Other studies, however, have not found that GAD was particularly associ-
ated with childhood emotional, physical, or sexual abuse (Gibb et al., 2007; Pribor &
Dinwiddie, 1992). Although further research is needed on specific GAD samples, the
diathesis– stress research on anxious states and symptoms more generally suggests that
various personality constructs and life events are probable contributors to the develop-
ment of generalized anxiety and worry (e.g., Brozina & Abela, 2006).
Clinician Guideline 10.8
Assessment for generalized anxiety should include a thorough investigation of stressful
life events and circumstances as well as certain broad personality dimensions like negative
affect, trait anxiety, and negative emotionality or neuroticism.Cognitive moDel of gaDFigure 10.1 presents an elaborated cognitive model of GAD that is based on the generic
model we discussed in Chapter 2 as well as on theoretical considerations discussed in
Beck and D. A. Clark (1997). In addition we are indebted to the advances made by other
researchers on the cognitive basis of generalized anxiety and worry (e.g., Borkovec,
1994; Borkovec et al., 1991; Dugas, Gagnon, et al., 1998; M. W. Eysenck, 1992; Wells,
1995, 1999; Woody & Rachman, 1994).