Cognición y emoción en el trastorno por ansiedad generalizada. Implicaciones clínicas

  1. José Mª. Prados
Revista:
Informació psicològica

ISSN: 0214-347X

Año de publicación: 2011

Número: 102

Páginas: 47-62

Tipo: Artículo

Otras publicaciones en: Informació psicològica

Resumen

El actualmente denominado trastorno por ansiedad generalizada (TAG), al que algunos expertos consideran que habría que cambiarle el nombre para la quinta versión del DSM, parece ser uno de los problemas psicológicos más frecuentes, con un índice de prevalencia vital en torno al 2,8%. Pese a su elevada frecuencia, la comprensión sobre la naturaleza de este trastorno es todavía escasa, porque hasta 1980 no fue considerado una categoría diagnóstica con entidad propia y porque aún no ha generado tanta investigación como lo han hecho otros trastornos. No obstante, esta situación empieza a cambiar y cada vez son más los investigadores centrados en el TAG, especialmente los que estudian los procesos cognitivos y emocionales implicados en el trastorno. Objetivo. El objetivo de este trabajo es exponer, de la forma más sintética posible, parte del conocimiento acumulado hasta ahora sobre el TAG, respecto a sus criterios diagnósticos, las aproximaciones teóricas, las herramientas de evaluación disponibles y los últimos avances terapéuticos.

Referencias bibliográficas

  • Akiskal, H. S. (1998). Toward a definition of generalized anxiety disorder as an anxious temperament type. Acta Psychiatrica Scandinavica, 98(suppl. 393), 66-73.
  • Alario Ballester, S. (1989). Tratamiento de un trastorno por ansiedad generalizada. Análisis y Modificación de conducta, 15, 305-316.
  • Aldao, A., Mennin, D. S., Linardatos, E., & Fresco, D. M. (2010). Differential patterns of physical symptoms and subjective processes in generalized anxiety disorder and unipolar depression. Journal of Anxiety Disorders, 24, 250-259.
  • Andrews, G., Hobbs, M. J., Borkovec, T. D., Beesdo, K., Craske, M.G.,... Stanley, M. A. (2010). Generalized worry disorder: A review of DSM-IV generalized anxiety disorder and options for DSM-IV. Depression and Anxiety, 27, 134-147.
  • Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18(3), 249-255.
  • Bados, A., y Bach, L. (1997). Intervención psicológica con una paciente con trastorno de ansiedad generalizada. Análisis y Modificación de Conducta, 23, 85-107.
  • Bandelow, B., Wedekind, D., & Leon, T. (2007). Pregabalin for the treatment of generalized anxiety disorder: A novel pharmacologic intervention. Expert Review of Neurotherapeutics, 7, 769-181.
  • Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Londres: Guilford.
  • Barlow, D. H., y Durand, V. M. (2003). Psicopatología (3ª Ed.). Madrid: Thomson.
  • Barlow, D. H., Rapee, R. M., & Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23, 551-570.
  • Beck, A. T., Rush, A. J., Shaw, B. F., y Emery, G. (1983). Terapia cognitiva de la depresión. Bilbao: Desclée de Brouwer (Original de 1979).
  • Becker, E. S., Goodwin, R., Holting, C., Hoyer, J., & Margraf, J. (2003). Content of worry in the community: What do people with generalized anxiety disorder or other disorders worry about? Journal of Nervous and Mental Disease, 191, 688-691.
  • Beesdo, K., Hoyer, J., Jacobi, F., Low, N. C. P., Hofler, M., & Wittchen, H.-U. (2009). Association between generalized anxiety levels and pain in a community sample: evidence for diagnostic specificity. Journal of Anxiety Disorders, 23, 684–693.
  • Benedito, M. C., y Botella, C. (1992). El tratamiento de la ansiedad generalizada por medio de procedimientos cognitivo-conductuales. Psicothema, 4, 479-490.
  • Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77-108). New York: Guilford Press.
  • Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalised anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611-619.
  • Borkovec, T. D., & Mathews, A. M. (1988). Treatment of nonphobic anxiety disorders: A comparison of nondirective, cognitive and coping desensitization therapy. Journal of Consulting and Clinic Psychology, 56, 877-884.
  • Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288-298
  • Borkovec, T. D., Wilkinson, L., Folensbee, R., & Lerman, C. (1983). Stimulus control applications to the treatment of worry. Behaviour Research and Therapy, 21, 247-251.
  • Bradley, B.P., Mogg, K., Millar, N., & White, J. (1995). Selective processing of negative information: Effects of clinical anxiety, concurrent depression and awareness. Journal of Abnormal Psychology, 104, 532-536.
  • Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV). San Antonio, TX: Psychological Corporation.
  • Brown, T. A., DiNardo, P. A., Leham, C. S., & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the clasification of emotional disorders. Journal of Abnormal Psychology, 110, 49-58.
  • Butler, G., Fennell, M., Robson, P., & Gelder, M. (1991). Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 59, 167- 175.
  • Carter, N. J., & McCormack, P. L. (2009). Duloxetine: a review of its use in the treatment of generalized anxiety disorder. CNS Drugs, 23, 523-541.
  • Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279-296.
  • Craske, M., Rapee, R., Jackel, L., & Barlow, D. (1989). Quality dimensions of worry in DSM-III-R generalized anxiety disorder subjects and non-anxious controls. Behaviour Research and Therapy, 27, 397-402.
  • Crits-Christoph, P. (2002). Psychodynamic-interpersonal treatment of generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 81-84.
  • Crits-Christoph, P., Newman, M. G., Rickels, K., Gallop, R., Connolly Gibbons, M. B., ... Pastva, A. M. (2011). Combined medication and cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 25, 1087- 1094.
  • Davey, G. C. L. (2006). A mood-as-input account of perseverative worrying. En G. C. L. Davey y A. Wells (Eds.), Worry and its Psychological Disorders. Chichester, UK: Wiley.
  • Davey, G. C. L., Jubb, M., & Cameron, C. (1996). Catastrophic worrying as a function of changes in problemsolving confidence. Cognitive Therapy and Research, 20, 333-344.
  • Davey, G. C. L., Tallis, F., & Capuzzo, N. (1996). Beliefs about the consequences of worrying. Cognitive Therapy and Research, 20, 499-520.
  • DeBellis, M. D., Casey, B. J., Dahl, R. E., Birmaher, B., Williamson, D. E., Thomas, K. M., … Ryan, N. D. (2000). A pilot study of amygdala volumes in pediatric generalized anxiety disorder. Biological Psychiatry, 48, 51-57.
  • Drews, A., & Hazlett-Stevens, H. (2008). Relationships between irritable bowel syndrome, generalized anxiety disorder, and worry-related constructs. International Journal of Clinical and Health Psychology, 8, 429–436.
  • Dugas, M. J. (2000). Generalized anxiety disorder publications: so where do we stand? Journal of Anxiety Disorders, 14, 31–40.
  • Dugas, M. J., Freeston, M. H., Provencher, M. D., Lachance, S., Ladouceur, R., & Gosselin, P. (2001). Le Questionnarie sur l’inquiétude et l’anxiété: Validation dans les échantillions non cliniques et cliniques. Journal de Thérapie Comportementale et Cognitive, 17, 31-36.
  • Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-226.
  • Dugas, M. J., & Ladouceur, R. (2000). Treatment of GAD: Targeting intolerance of uncertainty in two types of worry. Behavior Modification, 24, 635-657.
  • Dugas, M. J., Marchand, A., & Ladouceur, R. (2005). Fur- ther validation of a cognitive-behavioral model of generalized anxiety disorder: Diagnostic and symptom specificity. Journal of Anxiety Disorders, 19, 329-343.
  • Dupuy, J-B., & Ladouceur, R. (2008). Cognitive processes of generalized anxiety disorder in comorbid generalized anxiety disorder and major depressive disorder. Journal of Anxiety Disorders, 22, 505-514.
  • Durham, R. C., & Allan, T. (1993). Psychological treatment of generalized anxiety disorder: A review of the clinical significance of results in outcome trials since 1980. British Journal of Psychiatry, 163, 19-26.
  • Durham, R. C., Murphy, T., Allan, T., Richard, K., Treliving, L. R., & Genton, G. (1994). Cognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder. British Journal of Psychiatry, 165, 315-323.
  • D’Zurilla, T. J. (1993). Terapia de resolución de conflictos. Bilbao: Desclée de Brouwer (Original de 1986).
  • Eisen, A. R., & Silverman, W. K. (1998). Prescriptive treatment for generalized anxiety disorder in children. Behavior Therapy, 29, 105-121.
  • Engle, R., & Kane, M. J. (2004). Executive attention, working memory capacity, and a two factor theory of cognitive control. Psychology of Learning and Motivation, 44, 145-199.
  • Eysenck, M. W. (1997). Anxiety and cognition: An unified theory. Hove, UK: Psychology Press.
  • Etkin, A., Prater, K. E., Schatzberg, A. F., Menon, V., & Greicius, M. D. (2009). Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. Archives of General Psychiatry, 66, 1361–72.
  • Fisher, P. L., & Wells, A. (2009). Psychological models of worry and generalized anxiety disorder. In M. M. Antony and M. B. Stein, Oxford handbook of anxiety and related disorders (pp. 225-237). New York: Oxford University Press.
  • Francis, K., & Dugas, M. J. (2004). Assessing positive beliefs about worry: Validation of a structured interview. Personality and Individual Differences, 37, 405-415.
  • Freeston, M. H., Rhéame, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791-802.
  • Friedman, B. H., Thayer, J. F., & Borkovec, T. D. (2000). Explicit memory bias for threat words in generalized anxiety disorder. Behavior Therapy, 31, 745-756.
  • Gentes, E. L., & Ruscio, A. M. (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clinical Psychology Review, 31(6), 923-933.
  • González, M., Bethencourt, J. M., Fumero, A., y Fernández, A. (2006). Adaptación española del cuestionario “¿Por qué preocuparse?”. Psicothema, 18, 313-318.
  • Gordon, D., & Heimberg, R. G. (2011). Reliability and validity of DSM-IV generalized anxiety disorder features. Journal of Anxiety Disorders, 25, 813-821.
  • Gould, R., Otto, M., Pollack, M., & Yap, L. (1997). Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: A preliminary meta-analysis. Behavior Therapy, 28, 285–281.
  • Hayes, S. C., Strosahl, K., & Wilson, K. (1999). Acceptance and commitment therapy. New York: Guilford Press.
  • Hazlett, R. L., McLeod, D. R., & Hoehn-Saric, R. (1994). Muscle tension in generalized anxiety disorder: Elevated muscle tonus or agitated movement? Psychophysiology, 31, 189-195.
  • Hazlett-Stevens, H., & Borkovec, T. D. (2004). Interpretive cues and ambiguity in generalized anxiety disorder. Behaviour Research and Therapy, 42, 881-892.
  • Heimberg, R. G., Turk, C. L., & Mennin, D. S. (Eds.) (2004). Generalized Anxiety Disorder: Advances in research and practice. New York: Guilford Press.
  • Hettema, J. M. (2008). The nosologic relationship between generalized anxiety and major depression. Depression and Anxiety, 25, 300–316.
  • Hirsch, C.R., Hayes, S., & Mathews, A. (2009). Looking on the bright side: Accessing benign meanings reduces worry. Journal of Abnormal Psychology, 118, 44-54.
  • Hudson, J. L., & Rapee, R. M. (2004). From anxious temperament to disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 51-74). New York: Guilford Press.
  • Huerta, F., Gómez, S., Molina, A., y Luciano, M. C. (1998). Ansiedad generalizada: un estudio de caso. Análisis y Modificación de Conducta, 24, 751-766.
  • Ibáñez, I., González, M., Fernández-Valdés, A., LópezCurbelo, M., Rodriguez, M., y García, C. (2000). El cuestionario de preocupación y ansiedad: un instrumento para la evaluación del trastorno por ansiedad generalizada. Ansiedad y Estrés, 6(2-3), 203-221.
  • Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100-110.
  • Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1992). Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry, 49(4), 267-272.
  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of twelwemonth DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617-627.
  • Koster, E. H. W., Crombes, G., Verschuere, B., Van Damme, S.,& Wiersema, J. R. (2006). Components of attentional bias to threat in high trait anxiety: facilitated engagement, impaired disengagement, and attentional avoidance. Behaviour Research and Therapy, 44, 1757– 1771.
  • Kranzler, H. (1988). Use of buspirone in an adolescent with overanxious disorder. Journal of American Academy of Child and Adolescent Psychiatry, 27, 789-790.
  • Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000). Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68, 957-964.
  • Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000). Experimental manipulation of intolerance of uncertainty: A study of a theoretical model of worry. Behaviour Research and Therapy, 38, 933-941.
  • Lieb, R., Becker, E., & Altamura, C. (2005). The epidemiology of generalized anxiety disorder in Europe. European Neuropsychopharmacology, 15, 445-452.
  • Lindsey, W., Gamsu, C., McLaughlin, E., Hood, E., & Espie, C. A. (1987). A controlled trial of treatments for generalized anxiety. British Journal of Clinical Psychology, 26, 3-15.
  • MacLeod, A. K. (1994). Worry and explanation-based pessimism. In G. C. L. Davey and F. Tallis (Eds.), Worrying: perspectives on theory, assessment and treatment (pp. 115-134). Chichester, UK: Wiley.
  • McLaughlin, K.A., Mennin, D.S., & Farach, F.J. (2007). The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder. Behaviour Research and Therapy, 45, 1735-1752.
  • Masi, G., Millepiedi, S., Mucci, M., Poli, P., Bertini, N., & Milantoni, L. (2004). Generalized anxiety disorder in referred children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 752-760.
  • Mennin, D. S., Heimberg, R. G., Fresco, D. M., & Ritter, M. R. (2008). Is generalized anxiety disorder an anxiety or mood disorder? Considering the multiple factors as we ponder the fate of GAD. Depression and Anxiety, 25, 289–299.
  • Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281-1310.
  • Meyer, T., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.
  • Mitte, K. (2005). Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: A comparison with pharmacotherapy. Psychological Bulletin, 131, 785-795.
  • Mogg, K., Baldwin, D. S., Brodrick, P., & Bradley, B. P. (2004). Effect of short-term SSRI treatment on cognitive bias in generalized anxiety disorder. Psychopharmacology, 176, 466-470.
  • Montorio, I., Losada, A., Márquez, M., y Nuevo, R. (2000). Programa psicoeducativo de tratamiento de la preocupación patológica en personas mayores. Un estudio piloto. Revista Española de Geriatría y Gerontología, 35, 24-29.
  • Montorio, I., Wetherell, J. L., & Nuevo, R. (2006). Beliefs about worry in community-dwelling older adults. Depression and Anxiety, 23, 466-473.
  • Muris, P., Meesters, C., Merckelbach, H., & Hülsenbeck, P. (2000). Worry in children is related to perceived parental rearing and attachment. Behaviour Research and Therapy, 38, 487-497.
  • Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215-233.
  • Nuevo, R. (2005). Sensibilidad y especificidad del cuestionario de preocupación y ansiedad para la detección del trastorno de ansiedad generalizada en la edad avanzada. Revista de Psicopatología y Psicología Clínica, 10, 135-142.
  • Nuevo, R., y Montorio, I. (2005). Eficacia de un tratamiento cognitivo-conductual para la preocupación excesiva en personas mayores. International Journal of Clinical and Health Psychology, 5, 215-226.
  • Nuevo, R., Montorio, I., & Borkovec, T.D. (2004). A test of the role of metaworry in the prediction of worry severity in an elderly sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 209-218.
  • Nutt, D. J. (2001). Neurobiological mechanisms in generalized anxiety disorder. Journal of Clinical Psychiatry, 62 (Suppl. 11), 22-27.
  • Orgilés, M., Méndez, X., Rosa, A. I., e Inglés, C. J. (2003). La terapia cognitivo-conductual en problemas de ansiedad generalizada y ansiedad por separación: un análisis de su eficacia. Anales de Psicología, 19, 193-204.
  • Öst, L. G., & Breitholtz, E. (2000). Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy, 38, 777-790.
  • Owen, R. T. (2007). Pregabalin: Its efficacy, safety and tolerability profile in generalized anxiety. Drugs of Today, 43, 601–610.
  • Pluess, M., Conrad, A., & Wilhelm, F. H. (2009). Muscle tension in generalized anxiety disorder: a critical review of the literature. Journal of Anxiety Disorders, 23, 1–11.
  • Power, K., Jerrom, D., Simpson, R., Mitchell, M., & Swanson, V. (1989). A controlled comparison of cognitivebehavior therapy, diazepam and placebo in the management of generalised anxiety. Behavioural Psychotherapy, 17, 1-114.
  • Power, K., Simpson, R., Swanson, V., & Vallace, L. (1990). A controlled study of cognitive-behavior therapy, diazepam, and placebo, alone and in combination for the treatment of generalised anxiety. Journal of Anxiety Disorders, 4, 267-292.
  • Prados, J. M. (2007). Desarrollo de una nueva escala de creencias sobre las consecuencias de la preocupación. Anales de Psicología, 23, 226-230.
  • Prados, J. M. (2008). Ansiedad generalizada. Madrid: Síntesis.
  • Prados, J. M. (2011). Do beliefs about the utility of worry facilitate worry? Journal of Anxiety Disorders, 25, 217-223.
  • Raskin, M., Bali, L., & Peeke, H. (1980). Muscle biofee- dback and trascendental meditation: Controlled evaluation of efficacy in the treatment of chronic anxiety. Archives of General Psychiatry, 37, 93-97.
  • Rickels, K., & Rynn, M. A. (2001). What is generalized anxiety disorder? Journal of Clinical Psychiatry, 62 (Suppl. 11), 4-12.
  • Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2008). The factor structure and dimensional scoring of the generalized anxiety disorder questionnaire for DSMIV. Assessment, 15, 343–350.
  • Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 8, 54-68.
  • Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083-1089.
  • Rosen, V. M., & Engle, R. W. (1998). Working memory capacity and suppression. Journal of Memory and Language, 39, 418-436.
  • Rynn, M. A., Siqueland, L., & Rickels, K. (2001). Placebocontrolled trial of sertraline in the treatment of children with generalized anxiety disorder. American Journal of Psychiatry, 158, 2008-2014.
  • Schienle, A., Ebner, F., & Schäfer, A. (2011). Localized gray matter volume abnormalities in generalized anxiety disorder. European Archives of Psychiatry and Clinical Neuroscience, 261(4), 303-307.
  • Sinha, S. S., Mohlman, J., & Gorman, J. M. (2004). Neurobiology. In R.G. Heimberg, C.L. Turk, y D.S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 187-216). New York: Guilford Press.
  • Silverstone, P. H., & Salinas, E .O. (2001). Efficacy of venlafaxine ER in patients with major depressive disorder and co-morbid generalized anxiety disorder. Journal of Clinical Psychiatry, 62, 523-529.
  • Simeon, G., Ferguson, H. B., Knott, V. (1992). Clinical, cognitive and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorders. Journal of the American Academy of Child and Adolescence Psychiatry, 31, 29-33.
  • Spitzer R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097.
  • Stanley, M. A., Diefenbach, G. J., & Hopko, D. R. (2004). Cognitive behavioral treatment for older adults with generalized anxiety disorder. A therapist manual for primary care settings. Behavior Modification, 28, 73-117.
  • Starcevic, V. (1995). Pathological worry in major depression: Preliminary report. Behaviour Research and Therapy, 33, 55-57.
  • Starcevic, V., & Bogojevic, G. (1999). The concept of generalized anxiety disorder: Between the too narrow and too wide diagnostic criteria. Psychopathology, 32, 5–11.
  • Stöber, J. (1998). Worry, problem elaboration and suppression of imagery: The role of concreteness. Behaviour Research and Therapy, 36, 751-756.
  • Stöber, J., & Borkovec, T. D. (2002). Reduced concreteness of worry in generalized anxiety disorder: Findings from a therapy study. Cognitive Therapy and Research, 26, 89-96.
  • Tallis, F., & Eysenck, M. W. (1994). Worry: Mechanisms and modulating influences. Behavioural and Cognitive Psychotherapy, 22, 37-56.
  • Tallis, F., Eysenck, M. W., & Mathews, A. (1992). A questionnaire for measurement of non pathological worry. Personality and Individual Differences, 13, 161-168.
  • Tan, S., Moulding, R., Nedeljkovic, M., & Kyrios, M. (2010). Metacognitive, cognitive and developmental predictors of generalised anxiety disorder symptoms. Clinical Psychologist, 14(3), 84-89.
  • Tyrer, P., & Baldwin, D. (2006). Generalised anxiety disorder. Lancet, 368, 2156–2166.
  • Wells, A. (1994). A multi-dimensional measure of worry: Development and preliminary validation of the Anxious Thoughts Inventory. Anxiety, Stress and Coping, 6, 289- 299.
  • Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301-320.
  • Wells, A. (2005). The Metacognitive Model of GAD: Assessment of Meta-Worry and relationship with DSM-IV Generalized Anxiety Disorder. Cognitive Therapy and Research, 29, 107-121.
  • Wells, A., & King, P. (2006). Metacognitive therapy for generalized anxiety disorder: An open trial. Journal of Behavior Therapy and Experimental Psychiatry, 37, 206-212.
  • Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: Properties of the MCQ-30. Behaviour Research and Therapy, 42, 385-396.
  • Wisocki, P. A., Handen, B., & Morse, C. (1986). The worry scale as a measure of anxiety among homebound and community elderly. Behavior Therapist, 5, 91-95.
  • Wittchen, H.-U. (2002). Generalized anxiety disorder: prevalence, burden, and cost tosociety. Depression and Anxiety, 16, 162–171.
  • Wittchen, H-U., & Hoyer, J. (2001). Generalized anxiety disorder: Nature and course. Journal of Clinical Psychiatry, 62 (Suppl. 11), 15-19.
  • Wolpe, J. (1981). Psicoterapia por inhibición recíproca (5ª ed.). Bilbao: Desclée de Brouwer (Orig. 1958).