Preliminary Investigation of an Innovative Theory-Driven Clinical Intervention for Treating Generalized Anxiety Disorder

This research addresses a novel intervention approach to treating generalized anxiety disorder (GAD), a chronic state of diffuse anxiety and excessive and controllable worry that affects between 4% and 6% of the population. This disorder remains one of the most challenging, debilitating and treatment refractory of the anxiety disorders. GAD affects functioning at many levels, as individuals with the disorder feel restless, irritable, have difficulty concentrating, tire easily, and typically suffer from chronic muscle tension and insomnia (Thayer, Friedman, & Borkovec, 1995). In fact, recent studies suggest that generalized anxiety disorder often has disabling effects that are as serious as, if not more serious than, those of chronic somatic diseases, substance dependence, and major depression (Kessler, in press). Research has shown that cognitive-behavior therapy (CBT) is one of the most effective and frequently used treatments for anxiety disorders. CBT assumes that active strategies to modify dysfunctional patterns of thinking, such as worry and catastrophizing, can reduce anxiety and are effective for a range of anxiety disorders. Although such treatments are effective (Nathan & Gorman, 2002), response rates for GAD to date are only 50%. Thus, although CBT is an efficacious treatment, there is ample room for improvement.

Our research makes use of a novel clinical approach to further our understanding of generalized anxiety. According to the looming vulnerability model of anxiety (Riskind & Williams, 2006; Riskind, 1997a; Riskind & Williams, 2005; Riskind, Williams, Gessner, Chrosniak, & Cortina, 2000), anxiety is associated not only with the perception of a situation as threatening (a conceptualization shared with most cognitive models of anxiety), but specifically with a perception of the threatening situation as moving or even rushing toward the person in space or time. For example, a general, static perception or static display in the mind that one might fail a college course might arouse little anxiety, but a vivid image of an accelerating threat would contribute to heightened arousal and a significant increase in anxiety and worry. We are investigating a "looming-reduction" treatment package based on several innovative and promising interventions that we have developed on the basis of clinical work with patients with generalized anxiety disorder. We hypothesize that this treatment will produce significant reductions in generalized anxiety symptoms over time. Participants will be George Mason University undergraduate students who have been screened for GAD, and the interventions will be audio guided imagery to imagine worry situations as slowing down in time and space until they become virtually static. We predict that these interventions will produce significant reductions in symptoms of GAD over the period of one month. These results should show promise in improving treatment outcomes for this difficult, often refractory disorder and provide the basis for future funding of systematic treatment trials.


Dr. John H. Riskind

Dr. John H. Riskind is Professor Psychology at George Mason University. He previously served as a faculty and research director at the Center for Cognitive Therapy in the Department of Psychiatry at the University of Pennsylvania. He is the Editor of the International Journal of Cognitive Therapy and author of two book and numerous scientific papers. His research focuses on cognitive vulnerability factors in anxiety disorders and cognitive therapy, and particularly on his model of looming vulnerability. He is a Founding Fellow of the Academy of Cognitive Therapy. He and Dr. Rector have worked on numerous papers together on looming vulnerability and are currently writing two books together, one on the looming vulnerability model.


Dr. Neil A. Rector

Dr. Neil A. Rector previously served a Research Scientist in the Sunnybrook Research Institute and the Director of Research in the Department of Psychiatry, Sunnybrook Health Sciences Centre. He is also an Associate Professor of Psychiatry at the University of Toronto. He previously served as Director of the Anxiety Disorders Clinic at the Centre for Addiction and Mental Health at the University of Toronto. He is on the Editorial Board of several cognitive-behavioral journals and author of a book and numerous scientific papers and book chapters. His work focuses on cognitive-behavioral therapy treatments for anxiety disorders. He is a Founding Fellow at the Academy of Cognitive Therapy.


Dr. Michael E. Portman

Dr. Michael E. Portman, DPhil, LISW-S, is a staff therapist at the Cleveland Veterans Administration and has been an adjunct faculty member at Case Western Reserve University. He specializes in the research and treatment of generalized anxiety disorder and has authored a full length text on the subject called Generalized Anxiety Disorder Across The Lifespan: An Integrative Approach by Springer-Verlag, 2009. He also maintains a private practice, continues to be active in his research on GAD and trains advanced graduate students.


Evan Kleiman

Evan Kleiman is a second-year graduate student in the Clinical Psychology Ph.D. program at George Mason University. He received an honors' degree in Psychology from Temple University in Philadelphia. Evan's primary research interests include the looming vulnerability model of anxiety and protective factors in suicide, and the stress generation effect. In addition to examining interventions to Generalized Anxiety Disorder, Evan is involved in several other research projects with his mentor, Dr. John Riskind, including the stress generation effect, the notion that negative life events can both lead to and be a result of anxiety and looming vulnerability style.