Abstract
This paper offers a new learning theory-based conceptualization of worry in Generalized Anxiety Disorder (GAD). The authors suggest that the processes that produce GAD symptoms may vary across GAD sufferers and that treatment effectiveness may be enhanced if the process that likely produced symptoms in a given individual is understood. Specifically, they suggest that a “worry as adjunctive behavior” hypothesis be added to the “worry as anxiety” and “worry as avoidance behavior” hypotheses currently considered. This new hypothesis suggests that for some worriers, worry may function as an adjunctive behavior; that is, a way of accessing quick satisfaction when daily living produces too little response contingent reinforcement. The authors explain that life events that give rise to adjunctive behavior are the same as those that contribute to depression and that this might help explain the high comorbidity between GAD and depression. In cases in which worry appears to serve an adjunctive function, treating GAD symptoms as depression would be treated (e.g., with behavioral activation) may be the most successful course of action.
Highlights
This paper offers a new learning theory-based conceptualization of worry in Generalized Anxiety Disorder (GAD)
The authors summarize learning theory literature that explains that the experiences that contribute to depression should, in many cases, give rise to small behaviors that produce immediate satisfaction
We propose that a third hypothesis be added to the current set of learning theory conceptualizations of worry in GAD
Summary
Two learning theory models regarding the contribution of life experience to depression are foundational to current, effective psychotherapeutic interventions for depression. Everyday life can be viewed as a series of situations (SD s) that offer opportunities to engage in behaviors (Rs) that produce satisfying outcomes (SPR/NR s) contingent upon those behaviors. These might come about through the actual production of pleasurable consequences (i.e., positive reinforcement or PR) or the removal or minimization of painful events (i.e., negative reinforcement or NR). This proposal by Lewinsohn et al is consistent with observations offered by Ferster [29] and together these support the statement that behaving organisms (like human beings) need to impact their environments through their behavior Disruptions in many situations, or in situations that are very significant, may contribute to major depressive episodes while disruptions that are long term may contribute to dysthymic disorders
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