The importance of taking an integrative approach to the study of worry, intolerance of uncertainty, and generalized anxiety disorder.

AbstractGeneralized anxiety disorder (GAD) is characterised by excessive and uncontrollable worry and anxiety and a variety of associated symptoms, including muscle tension and restlessness. The consequences of a GAD diagnosis are well documented; however, GAD remains understudied in relation to other anxiety disorders. In addition, treatment recovery rates indicate that there is significant room for improvement in existing interventions. Although it is clear that we need more research on GAD and its underpinning processes, it is also proposed that the field would benefit from (a) more explicit knowledge synthesis, because some questions of current interest have been raised or addressed at various points in the past and (b) greater integration of nonclinical theories into conceptual models of pathological worry.Keywords: generalized anxiety disorder, integration, synthesis, theory, worryResumeLa caracteristique essentielle du trouble d'anxiete generalisee (TAG) est une inquietude excessive et incontrolable et de l'anxiete, s'accompagnant de divers symptomes, y compris de la tension musculaire et de l'agitation. Les consequences du TAG sont bien documentees, toutefois, ce trouble fait l'objet de moins de recherches que les autres troubles anxieux. De plus, les taux de retablissement par suite d'un traitement revelent qu'il y a bien du progres a faire sur le plan des interventions actuelles. Bien que le grand besoin de recherche sur le TAG et les procedes qui le sous-tendent soit evident, il est aussi propose que les praticiens beneficieraient a) d'une synthese plus explicite des connaissances, car certaines questions soulevees aujourd'hui l'ont deja ete par le passe, voire discutees; et b) d'une plus grande integration des theories non cliniques dans les modeles conceptuels de l'inquietude pathologique.Mots-cles : trouble d'anxiete generalisee, integration, synthese, theorie, inquietude.I thank the Canadian Psychological Association for this oppor- tunity to discuss a problem that is currently the focus of my research, and that is of considerable interest to the scientific community, health care professionals, and the public: worry, or talking to ourselves a lot about negative things, most often about negative events that we are afraid might happen in the future (Borkovec, Robinson, Pruzinksy, & DePree, 1983). Of particular interest to my research team is generalized anxiety disorder (GAD; American Psychiatric Association, 2013), a condition character- ised by excessive and uncontrollable worry in a number of do- mains (e.g., work, academic performance, interpersonal relation- ships). GAD-type worry is protracted and is accompanied by a variety of associated symptoms, such as muscle tension, restless- ness, and difficulty concentrating. Irritable bowel syndrome, pain, cardiac events, psychological comorbidity, and interpersonal prob- lems are also well documented in people with GAD (Beesdo et al., 2009; Borkovec, Newman, & Castonguay, 2003; Gros et al., 2009; Martens et al., 2010; Simon, 2009).Although problematic worry has been described in the clinical literature for well over 100 years (e.g., Walton, 1908), most of the growth in our understanding of the phenomenology and pathology of GAD has occurred over the last 30 years. A number of concep- tual models of worry and GAD have been constructed (see Behar et al., 2009 for a review; Hirsch & Mathews, 2012; Newman & Llera, 2011), and these have informed the development of effica- cious cognitive-behavioural treatments. However, GAD remains one of the more understudied anxiety disorders (Dugas et al., 2010), and the consensus has been that there remains room for improvement in its treatment (Hanrahan et al., 2013).So where do we go from here? The discourse in GAD research has focused largely on the need to generate new knowledge and insights into the causes of worry and the need to develop innova- tive interventions and make novel refinements to existing treat- ments. …

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