Emotion regulation deficits and three-hour ambulatory cardiovascular activity in generalized anxiety disorders.

摘要

This study investigated physiological, cognitive, and emotional factors associated with generalized anxiety disorder (GAD). Behavioral models of worry and GAD have generally focused on an internal avoidance response to fear that involves mainly cognitive and physiological contributors. Emotional models of GAD attempt to address the origins of emotional avoidance likely associated with GAD (Mennin, 2004). The emotion dysregulation model suggests that GAD is characterized by deficits in emotion regulation and excessive reliance on cognitive control strategies such as worry in order to reduce emotional experience. Regarding physiological characteristics of GAD, both theoretical perspectives converge on the notion that GAD is associated with a rigid autonomic response pattern, identified by low heart rate variability and blunted reactivity to perceived stressors, thought to reflect a physiological expression of avoidance. In developing a biopsychosocial conceptualization of GAD, serious limitations exist in the current empirical body of research. First, conflicting results from nearly identical experimental laboratory studies that investigated the relationship between worry and heart rate variability (Lyonfields et a1, 1995; Davis et al., 2005) question the replicability of such investigations. Additionally, inconsistencies exist regarding the characteristic dimensions of emotion dysregulation in GAD and how they relate to cognitive and physiological mechanisms. GAD has a high prevalence rate and a remarkably high level of comorbidity with other psychiatric and medical disorders. Unfortunately, empirically- supported treatments only produce clinically-significant change in half of patients receiving treatment. Despite these issues, GAD has received less attention from the scientific community in part because it has only been clearly defined since 1994. The present study used contemporary behavioral and emotional theory of GAD to delineate the association of worry, emotion regulation deficits, and cardiac activity using an ecological momentary assessment approach. This study was the first of its kind to investigate GAD and the relationships between physiological, cognitive, and emotional characteristics as they unfolded in the natural environment. Results indicated that GAD is associated with chronically-higher heart rate and lower heart rate variability than controls. Such findings support the autonomic rigidity hypothesis subsumed by behavior and emotion theory of GAD. However, the GAD group did not differ with controls on worry characteristics of frequency and intensity or trait and momentary assessments emotion dysregulation. Overall, this study supports a physiological profile characteristic of GAD and questions the association with current conceptualizations of worry and emotion dysregulation.