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Chapter 10
Cognitive Therapy
of Generalized Anxiety Disorder
There is nothing that wastes the body like worry....
—Ma h aT Ma ga n d h i (Indian philosopher,
humanitarian, and political leader, 1869–1948)Rebecca is a 38-year-old mother of two children who manages a large retail
clothing store with 150 employees and 15 department managers. Although a
very successful businesswoman who has risen rapidly through her company,
has received numerous work evaluations praising her abilities, and has been
promoted over her peers on a number of occasions, Rebecca is plagued by anxi-
ety, feelings of uncertainty, and worries about her personal effectiveness both
at work and at home. Although she traced her anxiety back to childhood and
has been a chronic worrier since adolescence, in the last 5 years her anxiety has
intensified with her job promotion and added work demands.
Numerous issues worried Rebecca including her aging parents’ health
problems, her own personal health, her children’s safety and performance at
school, family finances, and whether her marriage can survive the stresses of
two highly demanding careers. However, much of her daily worries focused
on work and whether she could meet her company’s expectations. She worried
that the store would miss its monthly productivity targets and she wondered
if her superiors perceived that she was less competent than other store manag-
ers. She worried that her employees had lost respect for her and that she had
been too soft and indecisive when dealing with employee discipline matters.
She worried that an employee might lodge a complaint against her to human
resources and that she would get entangled in messy litigation over her mana-
gerial practices. The regular reports submitted to company headquarters or a
visit to the store by the district manager triggered a particularly intense period
of anxiety. The underlying core belief that drove Rebecca’s work- related anxi-
ety concerned doubts about her own competence. She was fearful that others