Date of Award


Document Type


Degree Name

Doctor of Philosophy in Clinical Psychology



First Advisor

Nicholas Papouchis

Committee Chair and Members

Nicholas Papouchis, Chair

Sara Haden

Matthew Morrison


Anxiety Attachment, Emotion dysregulation, Generalized anxiety disorder, Insecure attachment, Shame


Generalized Anxiety Disorder (GAD) is a distressing condition characterized by excessive worry, and treatment outcomes are often unsatisfactory. Research has identified worry as an avoidance mechanism to manage interpersonal and emotional distress. Insecure attachment creates vulnerabilities for GAD, and research has demonstrated that emotion dysregulation plays an explanatory role in the association between insecure attachment and anxiety symptoms. The current study supported the role of emotion dysregulation in GAD for individuals with insecure attachment. Shame, measured explicitly and implicitly, was investigated as an additional mediator in the relationship between insecure attachment and anxiety. A sample of 355 adults completed self-report questionnaires on insecure attachment, emotion dysregulation, explicit shame, GAD symptoms, and worry, and the Implicit Association Test (IAT) to measure implicit shame. Results demonstrated that attachment anxiety predicted worry, emotion dysregulation, and explicit shame, while attachment avoidance predicted only emotion dysregulation. Emotion dysregulation and explicit shame predicted both worry and GAD symptoms. The study also found that attachment anxiety indirectly influenced anxiety through greater emotion dysregulation and explicit shame, with these factors fully accounting for the effect on GAD symptoms and partially explaining the effect on worry. Moreover, emotion dysregulation indirectly influenced anxiety through greater explicit and implicit shame. These findings highlight the roles of both emotion dysregulation and shame in GAD, particularly for individuals with anxious attachment. This study contributed to the understanding of the relationship between shame and anxiety and may inform future research, along with therapeutic interventions, for GAD.