Category: Adult Anxiety - GAD
GAD is an affective disorder (Hofmann et al., 2010) that is associated with emotion dysregulation (Mennin et al., 2009) and chronic, mildly elevated anxiety symptoms (Wittchen, 2002). Recent conceptualizations of GAD include the Emotion Dysregulation Model (EDM; Mennin et al., 2002) which implicates difficulties in emotion regulation as possible underlying processes that produce favorable outcomes when targeted directly in treatment. However, research on emotion dysfunction is limited, particularly with GAD patients seeking treatment. The current study aimed to test the explanatory power of specific difficulties in emotion regulation on the relations between GAD status and symptoms of anxiety.
A clinical sample of 110 patients (58.6% female) currently seeking treatment for an anxiety disorder were recruited. Participants completed a battery of questionnaires; Generalized Anxiety Disorder Questionnaire (GADQ-IV; Newman et al., 2002), used to categorize patients with GAD based of DSM-IV criteria; Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), measures several distinct dimensions of emotion dysregulation, including non-awareness and understanding of emotions, nonacceptance of emotions, inability to control impulsive behaviors and engage in desired goals when experiencing negative emotions, and lack of access to situationally appropriate emotion regulation strategies; Depression Anxiety Stress Scale - Anxiety (DASS; Lovibond & Lovibond, 1995), measures the negative emotional states of depression, anxiety, and stress.
Multiple mediation results will be presented, from which bootstrapping techniques using the Delta method were employed (Preacher and Hayes, 2008); on PROCESS for SPSS. In step 1 of the mediation model, the regression of GADQ-IV on anxiety symptoms (DASS Anxiety), ignoring the mediator, was significant, b=8.10, t(108)=3.87, p < .001. Step 2 showed that the regression of GADQ-IV on 3 of the 6 DERS subscales (impulsivity, goals, and strategies) were significant (p’s < .001; confidence intervals did not include zero). Step 3 showed that all DERS scales, controlling for GADQ-IV, were significant (p’s < .01; confidence intervals did not include zero). Step 4 of the mediation process revealed that controlling for DERS, GADQ-IV became a non-significant predictor of anxiety symptoms, b=4.03, t(101)=1.97, p>.05. A Sobel test found full mediation in 3 of the 6 models, specifically the DERS subscales of inability to control impulsive behavior, (z=2.33, p=.02); difficulty engaging in goal directed behavior, (z=2.18, p=.03); and limited access to emotion regulation strategies, (z=1.98, p=.04), which suggests that including these scales in the model significantly reduces the relationship between GADQ-IV and anxiety symptoms.
The results suggest that specific difficulties in emotion regulation are salient in GAD. Two factors (awareness and clarity) did not significantly explain the relationship between GAD and anxiety symptoms; this is not surprising given that individuals with GAD are highly vigilant of their symptoms. Three factors (impulsivity, goals, and strategies) significantly explained the relationship between GAD and anxiety symptoms. This model suggests that anxiety is maintained by the way individuals with GAD respond to their emotions, not how they experience emotion. Treatment and research implications of these findings, will be discussed.