Access Type

Open Access Dissertation

Date of Award

January 2013

Degree Type


Degree Name



Counselor Education

First Advisor

JoAnne Holbert


The intent of the study was to conduct a preliminary enquiry of the relationship between Generalized Anxiety Disorder (GAD) in women and hormonal imbalances, self-efficacy, and lifestyle. Key consideration was given to the study as it points to implications for licensed professional counselors and counselor educators. A nonexperimental, correlation design was used in the study and conducted in a large urban city in Ontario, Canada. Participants in the study were female clients receiving bio-identical hormone replacement therapy (BHRT) for a minimum of three month at a Medical Health Spa. A total of 55 participants completed a demographical survey, the Generalized Anxiety Disorder Scale (GAD-7), the General Self-Efficacy Scale, and the FANTASTIC checklist. Pearson product moment correlations were used to determine the strength and direction of the relationships between GAD and hormonal levels. Estriol was significantly related to GAD (r = -.33, p = .014). The negative direction of this relationship indicated that lower levels of estriol were associated with higher levels of GAD. A stepwise multiple linear regression analysis was used to determine which of the hormone levels, levels of self-efficacy, and healthy or unhealthy lifestyles could be used to predict GAD. Insight, a subscale of healthy and unhealthy lifestyles, entered the stepwise multiple linear regression equation, accounting for 40% of the variance in GAD (R2 = .40, F [1, 53] = 34.60, p < .001. The negative relationship between insight and GAD provided evidence that women who had higher scores for insight were likely to have lower scores for GAD. The Baron and Kenny (2012) four-step mediation analysis was used to determine if the relationship between hormonal levels and GAD was mediated by insight. One hormone was used in this analysis because estriol was the only hormone that was significantly related to GAD. Insight was a statistically significant mediator in the relationship between estriol and GAD. Implications for licensed professional counselors and counselor educators, as well as, recommendations for further research were included.