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Biological Explanations of Generalized Anxiety Disorder: Effects on Beliefs About Prognosis and Responsibility
Matthew S. Lebowitz, M.S., M.Phil.; John J. Pyun, B.S.; Woo-kyoung Ahn, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300011
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The authors are with the Department of Psychology, Yale University, New Haven, Connecticut (e-mail: matthew.lebowitz@yale.edu).

Copyright © 2014 by the American Psychiatric Association


Objective  Biological explanations of psychopathology can reduce the extent to which people with mental disorders are blamed for their symptoms but can also yield prognostic pessimism—the belief that psychiatric conditions are relatively immutable. However, few studies have examined whether these effects occur among persons who actually have psychiatric symptoms. This study sought to address this question.

Methods  Adults living in the United States (N=351) were recruited online in January and February 2012 and assessed for symptoms of generalized anxiety disorder. The participants were randomly assigned to two groups: a biological condition, in which participants (N=176) were provided a description of generalized anxiety disorder and a biological explanation of the etiology of the disorder, and a control condition, in which participants (N=175) were provided the same description without any explanation of etiology. Dependent measures of treatability, duration of symptoms, and responsibility for symptoms were used to gauge beliefs regarding the prognosis and personal responsibility of a typical person with generalized anxiety disorder.

Results  Among participants with and without symptoms of generalized anxiety disorder, the biological condition was associated with decreased ascriptions of personal responsibility for anxiety (p=.02) and expectations of increased duration of symptoms of generalized anxiety disorder (p=.01).

Conclusions  This finding has important social and clinical implications, especially because biological conceptualizations of psychopathology are increasingly prevalent. By causing prognostic pessimism about generalized anxiety disorder, including among those with symptoms of the disorder, biological explanations could negatively affect treatment seeking and outcomes. Efforts to dispel the link between biological explanations and prognostic pessimism are needed.

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Figure 1 Mean duration scores among participants in the biological and control conditions who did or did not meet the diagnostic cutoff on the Generalized Anxiety Disorder Questionnaire for DSM-IV (GADQ-IV)a

a Duration scores indicate expected symptom duration. Possible scores range from 1 to 8, with higher scores indicating expectations of longer duration. Error bars represent plus or minus 1 standard error.

Figure 2 Mean responsibility scores among participants in the biological and control conditions who did or did not meet the diagnostic cutoff on the Generalized Anxiety Disorder Questionnaire for DSM-IV (GADQ-IV)a

a Responsibility scores indicate the extent to which a person with generalized anxiety disorder is considered personally responsible for his or her symptoms. Possible scores range from 1, not at all, to 7, completely. Error bars represent plus or minus 1 standard error.



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