One of the most common problems confronted by health professionals of all kinds is anxiety. And yet, the nature of non-phobic anxiety (Generalized Anxiety Disorder and Panic Disorder) is poorly understood and treatments are largely untested. New theoretical developments in the study of anxiety point to a construct comprised of three loosely related response systems. In the absence of avoidance behavior, the two major response systems comprising non-phobic anxiety are: (1) somatic-physiological, and (2) subjective-cognitive. To date most treatments have dealt with only one or the other manifestation of anxiety. The purpose of this research plan is to test the most widely used psychosocial treatments for non-phobic anxiety to determine the effectiveness of these treatments compared to no treatment, compared to each other, and in combination compared to each treatment administered individually. The first treatment, targeting the somatic aspects of non-phobic anxiety, is relaxation. The second treatment, targeting the cognitive aspect of anxiety, is Beck and Emery's cognitive behavioral treatment for anxiety problems. These will be compared singly and in combination to a wait-list control group. Fifteen patients, carefully diagnosed and selected, will complete treatment in each of four groups. Progress will be assessed in each response system through administration of detailed physiological, behavioral, and cognitive assessment procedures. In addition, the correlation between cognitive and somatic measures of anxiety and the relationship of these changes to short and long-term outcome will be investigated in the context of a study of desynchrony. Long-term follow-up will determine the effectiveness of these procedures over a 3-year period, and treatment failures as well as relapses following treatment, will be evaluated and described. Finally, studies will continue on the validity and reliability of the subclassifications of Generalized Anxiety Disorder and Panic Disorder, and the differential effectiveness of treatment with these classifications will be explored in a large number of patients treated with the combined treatment.
