Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry and significant central nervous system arousal. It is prevalent, chronic, and associated with significant functional impairment (now recognized as comparable to major depressive disorder). Cognitive-behavioral therapies (CBT) for GAD have demonstrated a degree of efficacy, but results have been disappointing when compared to CBT for other anxiety and mood disorders. Typically, only half of CBT-treated patients achieve high end-state functioning. More efficacious psychosocial treatments for GAD are clearly needed. Currently available treatments for GAD may have achieved less than satisfactory outcomes because they have not adequately targeted the essential difficulties that underlie GAD. That is, they have attempted to quell excessive worry and quiet somatic arousal but have not addressed these symptoms functionally. They have not asked, """"""""Why does the person with GAD find worry an """"""""appealing"""""""" strategy for managing emotional distress?"""""""" We take an emotional regulation approach to this question. Extensive preliminary research by our group on emotion dysregulation in GAD suggests that, while experiencing emotions as more intensely aversive than other people, persons with GAD are unable to identify, describe or accept their emotional experience, react maladaptively to both negative and positive emotions, and feel less able to repair negative moods when they occur. Furthermore, they demonstrate greater difficulties regulating experimentally induced negative emotions than persons without GAD. Worry may be a strategic effort to avoid feared and unmanageable emotional experience. Therefore, this exploratory research grant application will develop and manualize an approach to the treatment of GAD that integrates cognitive-behavioral procedures with techniques to increase patients' emotional regulation skills. The manual will be initially developed with the input of a panel of scientists expert in CBT, emotion-focused approaches to psychotherapy, psychotherapy integration, and emotion regulation and will be further developed in an open clinical trial and a small-scale randomized clinical trial. Data generated in this effort will serve as the basis for later grant applications to further evaluate the utility of this emotion regulation approach to treatment of GAD. Relevance: GAD is a common mental health problem associated with significant distress and impairment. However, current psychotherapeutic procedures have been less than optimally effective, and this may be because they have not focused on an important part of GAD, the inability to regulate one's emotional experience. This application will develop and test a manualized therapy that combines the best of current cognitive-behavioral procedures with techniques designed to help persons with GAD better regulate their emotional experience. The newly developed treatment will be evaluated in a series of small studies. ? ? ?
