A Comparison of Transdiagnostic Components in Generalized Anxiety Disorder, Unipolar Mood Disorder and Nonclinical Population
Background: Dimensional and transdiagnostic approaches as a result of high comorbidity among mental disorders have captured researchers and clinicians interests for exploring the latent factors to development and maintenance of some psychological disorders. The goal of present study is comparing some of these common factors between generalized anxiety disorder and unipolar mood disorder. Methods: 27 patients with generalized anxiety disorder, 29 patients with depression disorder were recruited by using SCID-I and 69 non-clinical populations were selected by using GHQ cut off point. MANCOVA was used for analyzing data. Results: The results show that worry, rumination, intolerance of uncertainty, maladaptive metacognitive beliefs, and experiential avoidance were all significantly different between GAD and unipolar mood disorder groups. However, there weren’t any significant differences in difficulties in emotion regulation and neuroticism between GAD and unipolar mood disorder groups. Discussion: Results indicate that although there are some transdiagnostic and common factors in GAD and unipolar mood disorder, there may be some specific vulnerability factors for each disorder. Further study is needed for answering these questions.
A. Aldao, & S. Nolen-Hoeksema, "Specificity of cognitive emotion regulation strategies: A transdiagnostic examination", Behaviour research and therapy, 2010, vol. 48, no. 10, p. 974.
E. L. Gentes & A.M. Rusico, "A Meta-analysis of intolerance of uncertainty to symptoms of generalized anxiety disorder, major disorder, major depressive disorder, and obsessive-compulsive disorder", Clinical Psuchology Review, 2011, vol. 31, pp. 923-933.
Ehring, B. Tuschen-Caffier, J. Schnulle, S. Fischer, & JJ. Gross, "Emotion Regulation and Vulnerability to Depression: Spontaneous Versus Instructed Use of Emotion Suppression and Reappraisal Emotion", 2010, vol. 10, no. 4, pp. 563-572.
 K. K. Ellard, C. P. Fairholme, C. L. Boisseau, T. J. Farchione, D. H. Barlow, "Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data", Cognitive and Behavioral Practice, 2010, vol. 17, no. 1, pp. 88-101.
 A. Gumley, "Metacognition, affect regulation and symptom expression: A transdiagnostic perspective", Psychiatry research, 2011, vol. 190, no. 1, pp. 72-78.
 M. Lee & R. Shafran, "Information processing biases in eating disorders", Clinical Psychology Review, 2004, vol. 24, no. 2, pp. 215-238.
 Everaert, E. H. W, Koster, N. Derakshan, "The combined cognitive bias hypothesis in depression", Clinical Psychology Review, 2012, vol. 32, no. 5, pp. 413-424.
 E. E. Fitzsimmons & A. M. Bardone-Cone, "Coping and social support as potential moderators of the relation between anxiety and eating disorder symptomatology", Eating behaviors, 2011, vol. 12, no. 1, pp. 21-28.
 S. J. Egan, T. D. Wade, & R. Shafran, "Perfectionism as a transdiagnostic process: A clinical review, Clinical Psychology Review, 2011, vol. 31, no. 2, pp. 203-212.
 J. Roelofs, M. Huibers, F. Peeters, A. Amtz, J. Van Os, "Rumination and Worry as mediators in the relation between neuroticism and symptoms of depression and anxiety in clinivally depressed individuals", behaviour research and therapy, 2008, vol. 46, pp. 1239-1283.
 D. M. Fresco, A. N. Frankle, D. S. Mennin, C. L. Turk, R.G. Heimberg, "Distinct and Overlapping features of rumination and worry: The relationship of cognitive production to negative affection states" Cognitive Therapy and Research, 2002, vol. 26, pp. 179-188.
 A. Wells, M. Welford, P. King, C. Papageorgious, J. Wisely, Mendel, "A pilot randomized trial of metacognitive therapy VS applied relaxation in the treatment of adults with generalized anxiety disorder" behaviour research and therapy, 2010, vol. 48, pp. 429-434.
 A. E Yilmaz, T, Gencoz, A. WellS, "The temporal precedence of metacognition in the development of anxiety and depression symptoms in the context of life-stress: A prospective study, Journal of Anxiety Disorders, 2011, vol. 25, pp. 389-396.
 M. H. Freeston, J. Rheamue, H. Letarte, M. J. Dugas, R. Ladouceur, "why do people worry?", Personality and individual differences, 1994, vol. 17, no. 6, pp. 791-802.
 K. Buhr, M.J. Dugas, "The intolerance of uncertainty scale: psychometric properties of the English version", Behaviour research and therapy, 2002, vol. 40, no. 8, pp. 931-945.
 M. J. Dugas, P. Savard, A. Gaudet, J. Turcotte, N. Laugesen, M. Robichaud, et al, "Can the components of a cognitive model predict the severity of generalized anxiety disorder?", Behavior Therapym, 2007, vol. 38, no. 2, p. 169.
 P. M. McEvoy & A .E. J. Mahoney, "Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression", Journal of Anxiety Disorders, 2011, vol. 25, no. 1, pp. 112-122.
 S. C. Hayes, K. G. Wilson, E. V. Gifford, V. M. Follette, K. Strosahl, "Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment", Journal of consulting and Clinical Psychology, 1996, vol. 64, no. 6, p. 1152.
 S. A. Hayes, S. M. Orsillo, & L. Roemer, "Changes in proposed mechanisms of action during an acceptance-based behavior therapy for generalized anxiety disorder", Behaviour research and therapy, 2010, vol. 48, no. 3, pp. 238-245.
 T. B. Kashdan, N. Morina, & S. Priebe, "Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life", Journal of Anxiety Disorders, 2009, vol. 23, no. 2, p. 185.
 J. K. Lee, S. M. Orsillo, L. Roemer, L. B. Allen, "Distress and avoidance in generalized anxiety disorder: exploring the relationships with intolerance of uncertainty and worry", Cognitive behaviour therapy, 2010, vol. 39, no. 2, pp. 126-136.
 V. V. Busato, F. J. Prins, J. J. Elshout, C. Hamaker, "Intellectual ability, learning style, personality, achievement motivation and academic success of psychology students in higher education", Personality and Individual differences, 2000, vol. 29, no. 6, pp. 1057-1068.
 R. Gomez, & L. M. Francis," Generalized anxiety disorder: Relationship with Eysencks, Grays, and Newmans theories", Personality and individual differences, 2003, vol. 34, pp. 3-17.
 R. M. Bagby, K. D. Bindseil, D. R. Schuller, N. A. Rector, "Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients", Psychiatry research, 1997.
 C. F. Duggan, A. S. Lee, & R. M. Murray, "Does personality predict long-term outcome in depression?", The British Journal of Psychiatry, 1990, vol. 157, no. 1, pp. 19-24.
 J. J. Gross, "The emerging field of emotion regulation: An integrative review", Review of general psychology, 1998, vol. 2, no. 3, p. 271.
 D. S. Mennin, R. G. Heimberg, C. L. Turk, & D. M. Fresco, "Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder", Behaviour research and therapy, 2005, vol. 43, pp. 1281-1310.
 G. I. Liverant, T. A. Brown, D. H. Barlow, L. Roemer, "Emotion regulation in unipolar depression: the effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect", Behaviour research and therapy, 2008, vol. v46, pp. 1201-1209.
 D. S. Mennin, R. G. Heimberg, C. L. Turk, D. M. Fresco, "Applying an emotion regulation framework to integrating approaches to generalized anxiety disorder", Clinical Psychology: Science and Practice, 2002, vol. 9, pp. 131-138.
 T. B. Kashdan, V. Barrios, J. P. Forsyth, M. F. Steger, "Experiential aviodance as generalized psychological vulnerability comparisons with coping and emotion regulation strategies", behaviour research and therapy, 2006, vol. 44, pp. 1301-1320.
 R. de Jong-Meyer, B. Beck, K. Riede, "Relationships between rumination, worry, intolerance of uncertainty and metacognitive beliefs", Personality and Individual differences, 2009, vol. 46, no. 4, pp. 547-551.
 K. Yook, K. Kim, S. Suh, K. S. Lee, "Intolerance of uncertainty, worry, and rumination in major depressive disorder and generalized anxiety disorder", Journal of anxiety disorders, 2010, vol. 24, 623-628.
 R. Noyes, "Comorbidity in generalized anxiety disorder", Psychiatric Clinics of North America, 2001, vol. 24, no. 1, pp. 41-55.
 P. T. Ninan, "Dissolving the burden of generalized anxiety disorder", Journal of Clinical Psychiatry, 2001.
 O. Brawman-Mintzer, N. Emmanuel, M. P. Jarrell, J. C. Ballenger, "Psychiatric comorbidity in patients with generalized anxiety disorder", pathology, 1993, vol. 2, p. 4.
 S. E. Bruce, J. T. Machan, I. Dyck, M. B. Keller, "Infrequency of "pure" GAD: impact of psychiatric comorbidity on clinical course", Depression and anxiety, 2001, vol. 14, no. 4, pp. 219-225.
 T. A. Brown, & D. H. Barlow, "A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment", Psychological Assessment, 2009, vol. 21, no. 3, p. 256.
 R. F. Krueger, & K. E. Markon, "Reinterpreting comorbidity: A model-based approach to understanding and classifying psychopathology", Annual review of clinical psychology, 2006, vol. 2, p. 111.
 R. F. Krueger, "The structure of common mental disorders", Archives of General Psychiatry, 1999, vol. 56, no. 10, p. 921.
 R. M. A. Hirschfeld, "The comorbidity of major depression and anxiety disorders: recognition and management in primary care" , Primary care companion to the Journal of clinical psychiatry, 2001, vol. 3, no. 6, p. 244.
 J. D. Swendsen, K. R. Merikangas, G. J. Canino, R. C. Kessler, M. Rubio-Stipec, J. Angst, "The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities", Comprehensive Psychiatry, 1998, vol. 39, no. 4, pp. 176-184.
 R. Lieb, E. Becker, C. Altamura, "The epidemiology of generalized anxiety disorder in Europe", European Neuropsychopharmacology, 2005, vol. 15, no. 4, pp. 445-452.
 D. Nutt, S. Argyropoulos, S. Hood, J. Potokar, "Generalized anxiety disorder: A comorbid disease", European Neuropsychopharmacology, 2006, vol. 16, pp. 109-118.
 P. E. Greenberg, T. Sisitsky, R. C. Kessler, S. N. Finkelstein, E. R. Berndt, J. R. T Davidson, et al, "The economic burden of anxiety disorders in the 1990s", Journal of clinical psychiatry, 1999.
 K. A. Yonkers, M. G. Warshaw, A. O. Massion, M. B. Keller, "Phenomenology and course of generalised anxiety disorder", The British Journal of Psychiatry, 1996, vol. 168, no. 3, pp. 308-313.
 M. H. Rapaport, C. Clary, R. Fayyad, J. Endicott, "Quality-of-life impairment in depressive and anxiety disorders", American Journal of Psychiatry, 2005, vol. 162, no. 6, pp. 1171-1178.
 G. A. Brenes, "Anxiety, depression, and quality of life in primary care patients", Primary care companion to the Journal of clinical psychiatry, 2007, vol. 9, no. 6, p. 437.
 E. R. Henning, C. L. Turk, D. S. Mennin, D. M. Fresco, R. G. Heimberg, "Impairment and quality of life in individuals with generalized anxiety disorder", Depression and anxiety, 2007, vol. 24, no. 5, pp. 342-349.
 D. P. Chapman, & G. S. Perry, "Peer Reviewed: Depression as a Major Component of Public Health for Older Adults", Preventing chronic disease, 2008, vol. 5, no. 1.
 R. C. Kessler, P. Berglund, O. Demler, R. Jin, D. Koretz, K. R. Merikangas, et al, "The epidemiology of major depressive disorder", JAMA: the journal of the American Medical Association, 2003, vol. 289, no. 23, pp. 3095-3105.
 D. E. Marcotte, V. Wilcox-Goek, D. P. Redmon, "Prevalence and patterns of major depressive disorder in the United States labor force", The journal of mental health policy and economics, 1999, vol. 2, no. 3, pp. 123-131.
 L. B. Allen, J. C. I. Tsao, L. C. Seidman, J. Ehrenreich-May, L. K. Zeltzer, "A unified, transdiagnostic treatment for adolescents with chronic pain and comorbid anxiety and depression", Cognitive and Behavioral Practice, 2012, vol. 19, no. 1, pp. 56-67.
 E. R. Watkins, "Depressive rumination and co-morbidity: evidence for brooding as a transdiagnostic process", Journal of rational-emotive & cognitive-behavior therapy, 2009, vol. 27, no. 3, pp. 160-175.
 K. L. Loeb, J. Lock, R. Greif, D. le Grange, "Transdiagnostic theory and application of family-based treatment for youth with eating disorders", Cognitive and Behavioral Practice, 2010.
 J. Gruber, P. Eidelman, A. G. Harvey, "Transdiagnostic emotion regulation processes in bipolar disorder and insomnia", Behaviour research and therapy, 2008, vol. 46, no. 9, pp. 1096-1100.
 B. C. Chu, "Translating Transdiagnostic Approaches to Children and Adolescents", Cognitive and Behavioral Practice, 2012, vol. 19, no. 1, pp. 1-4.
 J. M. Owen, "Transdiagnostic cognitive processes in high trait anger", Clinical Psychology Review, 2011, vol. 31, no. 2, p. 193.
 P. J. Norton, "A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training", Behavior Therapy, 2011.
 V. R. Weersing, M. S. Rozenman, M. Maher-Bridge, J. V. Campo, "Anxiety, depression, and somatic distress: Developing a transdiagnostic internalizing toolbox for pediatric practice", Cognitive and Behavioral Practice, 2012, vol. 19, no. 1, pp. 68-82.
 M. B. First, M. Gibbon, "User's guide for the structured clinical interview for DSM-IV axis I disorders: SCID-1 clinician version", American Psychiatric Pub, 1997.
 V. Sharifi, S. M. Assadi, M. R. Mohammadi, H. Amini, H. Kaviani, Y. Semnani, et al., "A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders: psychometric properties", Comprehensive Psychiatry, 2009, vol. 50, no. 1, pp. 86-91.
 A. T. Beck, A. J. Rush, B. F. Shaw, G. Emery, "Cognitive therapy of depression: The Guilford Press", 1987.
 A. T. Beck, R. A. Steer, M. G. Carbin, "Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation", Clinical Psychology Review, 1988, vol. 8, no. 1, pp. 77-100.
 K. Dabson, & P. Mohammadkhani, "Psychometric Characteristics of Beck Depression Inventory–II in Patients with Major Depressive Disorder", journal of Rehabilitation, 2007, vol. 8, no. 29, pp. 82-88.
 L. Fata, B. Birashk, M. Atefvahid, K. Dabson, "Meaning assignment structures/schema, emotional states and cognitive processing of emotional information: comparing two conceptual frameworks", Iranian journal of psychiatry and clinical psychology, 2005, vol. 11, no. 3, pp. 312-326.
 A. T. Beck, N. Epstein, G. Brown, R. Steer, "An inventory for measuring clinical anxiety: Psychometric properties", Journal of Consulting & Clinical Psychology, 1988, vol. 56, 893-897.
 E. de Beurs, K. A. Wilson, D. L. Chambless, A. J. Goldstein, U. Feske, "Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia", Depression and anxiety, 1997, vol. 6, no. 4, pp. 140-146.
 T. Fydrich, D. Dowdall, D.L. Chambless, "Reliability and validity of the Beck Anxiety Inventory", Journal of Anxiety Disorders, 1992, vol., no. 1, pp. 55-61.
 H. Kaviani, & A. Mousavi, "Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI)", Tehran University Medical Journal, 2008, vol. 66, no. 2.
 T. J. Meyer, M. L. Miller, R. L. Metzger, T. D. Borkovec, "Development and validation of the Penn State worry questionnaire", Behaviour research and therapy, 1990, vol. 28, no. 6, pp. 487-495.
 T. A. Brown, M. M. Antony, D. H. Barlow," Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample", Behaviour research and therapy, 1992, vol. 30, no. 1, pp. 33-37.
 A. Borjali, F. Sohrabi, G. R. Dehshiri, M. Golzari, "Psychometrics Particularity of Farsi Version of Pennsylvania State Worry Questionnaire for College Students", 2010, vol. 4, no. 1, pp. 67-75.
 S. Nolen-Hoeksema, & J. Morrow, "A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake", Journal of personality and social psychology, 1991, vol. 61, no. 1, p. 115.
 S. Nolen-Hoeksema, L. E. Parker, J. Larson, "Ruminative coping with depressed mood following loss", Journal of personality and social psychology, 1994, vol. 67, no. 1, p. 92.
 A. Mansouri, R. A. Bakhshipour, A. M. Mahmoud, A. Farnam, A. Fakhari, "The comparison of worry, obsession and rumination in individual with generalized anxiety disorder, obsessive-compulsive disorder, major depression disorder and normal individual", psychological studies, 2012, , vol. 7, no. 4, pp. 55-74.
 A. Wells, & S. Cartwright-Hatton, "A short form of the metacognitions questionnaire: properties of the MCQ-30", Behaviour research and therapy, 2004, vol. 42, no. 4, pp. 385-396.
 S. G. Myers, & A. Wells, "Obsessive-compulsive symptoms: the contribution of metacognitions and responsibility", Journal of Anxiety Disorders, 2005, vol. 19, no. 7, p. 806.
 S. Shirinzadeh Dastgiri, M. A. Goodarzi, A. Ghanizadeh, M. R. Taghavi, "A comparison of metacognitive beleifs and responsibility in obsessive compulsive disorder, generalized anxiety disorder and nonclinical population", Iranian Journal of Psychiatry and Clinical Psychology, 2008, vol. 14, no. 1, pp. 46-55.
 C. C. Luhmann, K. Ishida, G. Hajcak, "Intolerance of uncertainty and decisions about delayed, probabilistic rewards", Behavior Therapy, 2011, vol. 42, no. 3, pp. 378-386.
 H. Hamidpour, B. Dolatshai, A. Dadkhah, "The Efficacy of Schema Therapy in Treating Women's Generalized Anxiety Disorder", Iranian journal of psychiatry and clinical psychology, 2011, vol. 16, no. 4, pp. 420-431.
 S. C. Hayes, K. D. Strosahl, K. G. Wilson, R. T. Bissett, J. Pistorello, D. Toarmino, et al, " Measuring experiential avoidance: A preliminary test of a working model", The Psychological Record, 2004, vol. 54, no. 4, pp. 553-578.
 F. W. Bond, S. C. Hayes, R. A. Baer, K. M. Carpenter, N. Guenole, H. K. Orcutt, et al, " Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance", Behavior Therapy, 2011, vol. 42m, no. 4, pp. 676-688.
 E. Abasi, L. Fata, R. Moloudi, H. Zarrabipour, " Psychometric properties of Persian Version of Acceptance and Action Questionnaire –II", Journal of Psychological Models and Methods, 2013, vol. 2, no. 9.
 H. J. Eysenck, "Manual of the Eysenck personality scales (EPS Adult)", London: Hodder & Stoughton, 1991.
 A. Bakhshipour, & S. Bagharian Khoroushani, "Paychometric properties of Eysenck personality questionnaire-revised (EPQ-R) short scale", Contemporary psychology, 2006, vol. 1, no. 2, pp. 3-12.
 J. J. Gross, & O. P. John, "Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being", Journal of personality and social psychology, 2003, vol. 85, no. 2, p. 348.
 K. L. Gratz, & L. Roemer, "Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale", Journal of Psychopathology and Behavioral Assessment, 2004, vol. 26, no. 1, pp. 41-54.
 P. Asghari, G. H. R. Pasha, M. Aminyan, "relationship between emotion regulation, mental stresses, and body image with eating disorders of women", Andishe va Raftar, 2009, vol. 4, no. 13, pp. 65-78.
 D. P. Goldberg, & V. Hillier, "A scaled version of the General Health Questionnaire", Psychological Medicine, 1979, vol. 9, no. 10, pp. 139-145.
 A. Taqavi, "validity and relaiability of general health questionnaire" psychological journal, 2001, pp. 381-398.
 S. Nolen-Hoeksema, "The role of rumination in depressive disorders and mixed anxiety/depressive symptoms", Journal of abnormal psychology, 2000, vol. 109, no. 3, p. 504.
 T. D. Borkovec, O. Alcaine, E. Behar, "Avoidance theory of worry and generalized anxiety disorder", Generalized anxiety disorder: Advances in research and practice, 2004.
 N. Koerner, & M. J. Dugas, "A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty", In Worry and its psychological disorders: Theory, assessment and treatment, 2006, pp. 201-216.
 M. J. Dugas, A. Schwartz, K. Francis, "Brief Report: Intolerance of Uncertainty, Worry, and Depression", Cognitive therapy and research, 2004, vol. 28, no. 6, pp. 835-842.
 R. P. Auerbach, J. R. Z Abela, M-H. R. Ho, "Responding to symptoms of depression and anxiety: Emotion regulation, neuroticism, and engagement in risky behaviors", Behavior Research and Therapy, 2007, vol. 45, 2182-2191.
 L. Campbell-Sills, D. H. Barlow, T. A. Brown, S. G. Hofmann, "Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders", Behaviour research and therapy, 2006, vol. 44, no. 9, 1251-1263.
 P. Muris, J. Roelofs, E. Rassina, I. Franken, F. Mayer, "Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression", Personality and individual differences, 2005, vol. 30, pp. 1105-1111.
 P. M. McEvoy, A. E. J. Mahoney, "To Be Sure, To Be Sure: Intolerance of uncertainty mediates symptoms of various anxiety and depression, Behavior Therapy, 2012, vil. 43, no. 3, pp. 533-545.
J. L. Trew, "Exploring the roles of approach and avoidance in depression: an integrative model", Clinical Psychology Review, 2011, vol. 31, no. 7, pp. 1156-1168.
K. A. McLaughlin, & S. Nolen-Hoksema, "Rumination as a Transdiagnostic factor in depression and anxiety", behaviour research and therapy, 2011, Vol. 48, pp.186-93.
K. A. McLaughlin, D. S .Mennin, & F. J. Farach, "The contributory role of worry in emotion regulation and dysregulation in generalized anxiety disorder", Behavior Research and Therapy, 2007, vol.45,pp. 1735-1752.
N. Chawla, & B Ostafin, "Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review", Journal of Clinical Psychology, 2007, vol. 63, no. 9, pp. 871-890.
P. M. McEvoy, M. L. Moulds, & A. E. J. Mahoney, "Mechanisms driving pre-and post-stressor repetitive negative thinking: Metacognitions, cognitive avoidance, and thought control", Journal of Behavior Therapy and Experimental Psychiatry, 2012.
S. M. Bögels & W. Mansell," Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention", Clinical Psychology Review, 2004, vol. 24, no. 7, pp. 827-856.