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to GAD and pathological worry (e.g., Dugas et al., 1995; Dugas et al., 2005; Ladouceur
et al., 1999; Robichaud & Dugas, 2005). Moreover, negative problem orientation may
interact with intolerance of uncertainty (Dugas et al., 1997) or catastrophizing (Davey,
Jubb, & Cameron, 1996) to increase the risk of engaging in pathological worry.
There is qualified support for Hypothesis 6. It is clear that individuals with GAD
do not suffer from problem- solving deficits but they do exhibit less confidence in their
problem- solving abilities. This negative problem orientation is primarily due to nega-
tive problem- solving beliefs rather than to more generalized negative expectations
(Robichaud & Dugas, 2005). Moreover, negative problem orientation combined with
a tendency to catastrophize and search for more certain solutions to a future nega-
tive situation will lead to an endless search for and then rejection of solutions to the
anticipated threatening situation. In this way the chronic worrier experiences repeated
failures to establish a sense of safety. Although much of this remains conjecture until
further research is conducted, at least some aspects of Hypothesis 6 (i.e., low problem-
solving confidence) have been partially supported in the empirical literature.
Clinician Guideline 10.14
Target dysfunctional beliefs about effective problem solving and the attainment of safety
from imagined future negative outcomes for change in cognitive therapy of GAD.Cognitive assessment anD Case formulationDiagnostic and Symptom Measures
As with the other anxiety disorders we recommend the ADIS-IV (Brown et al., 1994)
as the best diagnostic interview for GAD. The GAD module provides dimensional rat-
ings on excessiveness (i.e., frequency and intensity) and controllability of worry in eight
domains of interpersonal, work, health and daily living. In addition to questions on
key diagnostic features, the ADIS-IV assesses the context of worry, presence of safety-
seeking responses, and degree of interference in daily living. The ADIS-IV (lifetime
version) has good interrater reliability with a kappa of .67 for a principal diagnosis of
GAD (Brown, Di Nardo, et al., 2001). The main source of disagreement was between
GAD and a depressive disorder (60% of disagreements). The SCID-I/NP (First, Spitzer,
Gibbon, & Williams, 2002) is an alternative to the ADIS-IV but the reliability of the
more recent version of the interview has not been assessed in a large-scale study (Turk
et al., 2004).
Generalized Anxiety Disorder Questionnaire–IV
The Generalized Anxiety Disorder Questionnaire–IV (GAD-Q-IV; Newman et al.,
2002) is a nine-item questionnaire developed as a screening tool for GAD. The GAD-
Q-IV is a refinement of the original GAD-Q (Roemer, Borkovec, Posa, & Borkovec,
1995) intended to make it more compatible with DSM-IV criteria. The GAD-Q and
GAD-Q-IV have been used most extensively in analogue research to identify individuals
who might meet diagnostic criteria for GAD. Newman et al. (2002) found that a cutoff