Basic science and clinical application of the contrast avoidance model in generalized anxiety disorder

The Contrast Avoidance model (Newman & Llera, 2011) proposes that individuals with generalized anxiety disorder (GAD) are excessively sensitive to negative emotional shifts (contrasts) in response to unpleasant events, and thus recruit a state of sustained intrapersonal negativity via worry as a defensive stance against such shifting states. Here we review the basic science related to environmental, psychological, and biological risk factors in the development of such emotional sensitivities in GAD, and present evidence supporting the position that worry and maladaptive interpersonal styles are employed as defensive strategies to protect against emotional contrasts. We present 2 case examples to elucidate these issues, as well as to introduce specific clinical recommendations for targeting and treating these behaviors. Suggestions for futureavenues of research are also discussed.