Exploring the role of early maladaptive schemas and intolerance of uncertainty in generalized anxiety disorder.

Objectives: The impact of developmental factors has not been addressed in cognitive models and gold standard treatment of generalized anxiety disorder (GAD). The present study examined the relationship between adverse childhood experiences (ACEs), dysfunctional parental styles, intolerance of uncertainty (IoU) and early maladaptive schemas (EMS) with GAD symptomatology and diagnostic status. The relationship between these variables was compared between a low anxiety and clinical GAD group. We hypothesized that the low anxiety group would score significantly lower on these variables compared to the clinical GAD group.

Methods: Participants in the clinical GAD group (n = 38) were recruited via a clinical trial and screened for a primary diagnosis of GAD using the Diagnostic Interview for Anxiety, Mood and OCD and Related Neuropsychiatric Disorders (DIAMOND; Tolin et al., Assessment, 25, 2018, 3). Participants in the low anxiety group (n = 148) were undergraduate students scoring in the normal to mild range on the Depression Anxiety Stress Scales (DASS-21; Lovibond & Lovibond, Behav. Res. Ther., 33, 1995, 335) and within the normal range on the Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., Generalized Anxiety Disorder 7 (GAD-7). APA PsycTests, 2006).

Results: Hierarchical regression analysis indicated that IoU and two EMS (vulnerability to harm; self-sacrifice) were significant predictors of GAD-7 scores. Logistic regression analysis similarly found IoU and the EMS of vulnerability to harm as the only significant predictor of GAD group membership. ACEs and dysfunctional parental styles were not significant predictors.

Conclusions: These findings support further investigation of IoU and EMSs in models of GAD and the utility of targeting these cognitive vulnerabilities in enhancing treatment.