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Three studies provide preliminary support for an emotion dysregulation model of generalized anxiety disorder (GAD). In study 1, students with GAD reported heightened intensity of emotions, poorer understanding of emotions, greater negative reactivity to emotional experience, and less ability to self-soothe after negative emotions than controls. A composite emotion regulation score significantly predicted the presence of GAD, after controlling for worry, anxiety, and depressive symptoms. In study 2, these findings were largely replicated with a clinical sample. In study 3, students with GAD, but not controls, displayed greater increases in self-reported physiological symptoms after listening to emotion-inducing music than after neutral mood induction. Further, GAD participants had more difficulty managing their emotional reactions. Implications for GAD and psychopathology in general are discussed.

Approximately 5% of people will suffer from generalized anxiety disorder (GAD) at some point in their lives (Kessler et al., 1994). GAD is associated with significant role impairment (Wittchen, Zhao, Kessler, & Eaton, 1994), increased health care utilization (Blazer, Hughes, & George, 1991), increased health care costs and decreased productivityy (Greenberg et al., 1999). However, despite the prevalence of GAD and the suffering associated with it, GAD remains poorly understood relative to other anxiety disorders and, as a result, has been more difficult to treat. When compared to the other anxiety disorders, far fewer investigations have examined the psychopathological mechanisms involved in GAD (Dugas, 2000). Recently, theorists have begun to expand our understanding of GAD through the development of models that highlight the importance of worry. One of the most comprehensive accounts of the role of worry in GAD is Borkovec's avoidance theory (e.g., Borkovec, Alcaine, & Behar, 2004). Borkovec and colleagues have presented convincing empirical support for the notion that worry is a perseverative, cognitive activity that serves an avoidance function for persons with GAD. More specifically, Borkovec and colleagues argue that worry allows individuals to approach emotional topics at an abstract, conceptual level and, consequently, to avoid aversive images, autonomic arousal, and intense negative emotions in the short-run (for a review of numerous studies in support of this view, see Borkovec et al., 2004). However, over the long term, the individual is repeatedly confronted with the emotional material, frequently has a more intense experience of anxiety, and engages in repetitive worry to “dull” this experience. In doing so, the person again fails to fully confront the distressing stimuli, and emotional processing of aversive experiences is inhibited. As described above, from the perspective of the avoidance theory of worry, worry facilitates avoidance of the imagery and physiological arousal associated with negative emotion. However, the nature of the emotional experience that prompts individuals with GAD to engage in frequent avoidance strategies such as worry has not been directly addressed. Although individuals with GAD may use worry to avoid distressing emotional experience, the theory does not explain why this experience is so aversive that it would need to be avoided. To understand this, the characteristics of the emotional experience that may prompt avoidance need to be explored. Further, emotion may play a larger role in GAD than specifically in relation to worry. Emotion and its dysregulation may be integral, yet largely unexplored, factors in the psychopathology of GAD and thus may have important implications for treatment (see Samoilov & Goldfried, 2000). Conceptualizations of GAD may benefit from attention to advances in the fields of emotion theory (e.g., Ekman & Davidson, 1994), emotion regulation (e.g., Gross, 1998), and affective neuroscience (e.g., LeDoux, 1996). Contemporary theories of emotion emphasize its adaptive value (e.g., Gross, 1998). Theorists have argued that emotions are cues for readiness for action or “action tendencies” that work to establish, maintain, or disrupt relationships with particular internal and external environments that signify importance to the person (see Barlow, 2002). Emotion serves an information function, notifying individuals of the relevance of their concerns, needs, or goals in a given moment. Attention to the adaptive value to emotions may account for the resurgence of interest in the role of emotion in psychopathology and psychotherapy (e.g., Berenbaum, Raghavan, Le, Vernon, & Gomez, 2003; Greenberg, 2002; Kring & Bachorowski, 1999; Samoilov & Goldfried, 2000). Emotion regulation, as a field of study, examines how individuals influence, control, experience, and express their emotions (Gross, 1998, p. 275). In discussing regulation of one's own emotions, Thompson (1990) stresses the importance of the restraint of emotion, as well as its maintenance and enhancement. Clearly, needs to diminish emotional arousal to work effectively or contain one's anger in a public setting are aspects of emotion regulation. However, investigators have more recently argued for the importance of accentuating both positive and negative emotional experiences to gain a greater understanding of goal pursuit (see Bonnano, 2001). Adaptive regulation of emotions has been found to relate to positive functioning and emotional health. Salovey, Mayer, and colleagues (e.g., Mayer, Salovey, Caruso, & Sitarenios (2001) and Mayer, Salovey, Caruso, & Sitarenios (2003)) theorize that people differ in their ability to attend to, process, and act as a result of their emotions, which they have called emotional intelligence. Research has begun to accumulate that supports the functional benefits of emotional intelligence (e.g., Mayer et al., 2003). If greater ability to manage emotions is associated with productivity and positive emotional health, then low levels of emotion regulatory ability should be associated with psychopathology and difficulties in adjustment. Indeed, investigators have applied findings from emotion research to clinical phenomena such as unipolar depression (e.g., Rottenberg, Kasch, Gross, & Gotlib, 2002), eating disorders (e.g., Westen & Harnden-Fischer, 2001), and borderline personality disorder (e.g., Wagner & Linehan, 1999). Rottenberg and Gross (2003) caution that, when looking at the relationship between emotion dysregulation and psychopathology, investigators need to recognize that regulation occurs dynamically throughout different points in the emotion generative process. Using this perspective as a base, Mennin and colleagues (for an introduction to this perspective, see Mennin, Heimberg, Turk, & Fresco, 2002; Mennin, Heimberg, Turk, & Carmin, 2004) have developed an emotion dysregulation model of GAD. Emotion may become dysfunctional in individuals with GAD through a rapid temporal process of dysregulation involving (1) heightened intensity of emotions; (2) poor understanding of emotions; (3) negative reactivity to one's emotional state (e.g., fear of emotion); and (4) maladaptive emotional management responses. Heightened emotional intensity coupled with an inadequate base of knowledge about emotions and discomfort with emotional experience may lead individuals with GAD to use maladaptive coping strategies to control and constrain their emotional experience to decrease this aversive state. Rather than processing an emotion through attention, understanding, and experiencing (Foa & Kozak, 1986), they may utilize worry and other intra- and interpersonal processes to avoid the distress associated with these emotions. We have suggested that individuals with GAD have emotional reactions that occur more easily, quickly, and intensely than for most other people (i.e., heightened emotional intensity). They may frequently experience strong negative affect, which sometimes is elicited by situations that are not evocative to most other people. Consistent with the research showing that higher levels of emotional intensity are associated with more emotion expressivity (Gross & John, 1997), individuals with GAD may also express more of their emotions, especially negative emotions, than most other people. Being overly expressive of negative emotions on a regular basis may lead to criticism or rejection by others, which, in turn, may elicit high levels of negative affect in these emotionally sensitive individuals with GAD. Research suggests that individuals with GAD perceive their relationships with family, friends, and romantic partners as moderately to severely impaired (Turk, Mennin, Fresco, & Heimberg, 2000), and evidence is mounting that individuals with GAD may have interpersonal styles that contribute to the relationship problems that they perceive. Pincus and Borkovec (1994) and Eng and Heimberg (2004) found that the majority of individuals with GAD endorsed interpersonal styles that were best characterized as overly nurturant and intrusive. Individuals with GAD may also have difficulty identifying primary emotions such as anger, sadness, fear, disgust, and joy and instead experience their emotions as undifferentiated, confusing, and overwhelming (i.e., poor understanding of emotions). In this way, persons with GAD may be unable to access and utilize the adaptive information conveyed by their emotions. Difficulty identifying and describing emotions has been related to various forms of psychopathology (see Taylor, Bagby, Parker, & Alexander, 1997). Given strong emotional responses and a poor understanding of them, individuals with GAD may experience emotions as aversive and become anxious when they occur (i.e., negative reactivity to emotions). Associated reactions may include extreme hypervigilance for threatening information and activation of negative beliefs about emotions.