436 TREATMENT OF SPECIFIC ANXIETY DISORDERS
A decrease occurred in her level of anxiety and worry, and her mark in anatomy also
improved significantly.
Clinician Guideline 10.24
Improving tolerance of risk and uncertainty is an important goal of cognitive therapy of
GAD. Cognitive restructuring and systematic exposure to increasing amounts of uncertainty
will lead to better acceptance of the uncertainty associated with primary worry concerns.Constructive Problem- Solving Training
As noted previously, a negative problem orientation, low confidence in problem- solving
ability, and dissatisfaction with problem- solving outcome is common in GAD. As a
result training in problem solving is included in cognitive- behavioral treatment proto-
cols for GAD (e.g., Craske & Barlow, 2006). Robichaud and Dugas (2006), however,
have described the most extensive intervention for poor problem solving in GAD. They
first address the clients’ negative problem orientation by using cognitive restructuring
to modify dysfunctional beliefs involving doubts about one’s problem- solving ability, a
tendency to view problems as threatening, and pessimism about the outcome of problem
solving. The goal is to shift the client’s perspective from viewing the problem as a threat
to seeing it as an “opportunity” or challenge.
The second part of their intervention involves training in effective use of problem-
solving steps; (1) problem definition and goal setting, (2) generation of alternative solu-
tions, (3) decision making, and (4) solution implementation and verification (D’Zurilla
& Nezu, 2007). Cognitive intervention for negative problem orientation and poor
problem- solving skills may be especially useful when the worry concern is more real-
istic. For example, the student previously mentioned who worried about failing her
anatomy exam had a realistic worry. Her dysfunctional study habits would probably
result in poor exam performance. Thus part of her treatment involved training in prob-
lem solving to develop a more realistic and practical study routine. This also involved
dealing with her doubt and pessimism that any changes would be useless because she
held to an erroneous belief that adhering to her unrealistic, rigid study regimen would
eventually eliminate her feelings of uncertainty.
Clinician Guideline 10.25
Improvement in negative problem orientation and training in problem- solving ability are
included in cognitive therapy of GAD when the primary worry concerns a more realistic
negative outcome.Elaborative Processing of the Present
In the final sessions of cognitive therapy individuals with GAD are encouraged to shift
their attention from future- oriented threatening thoughts to being more fully attentive
to their thoughts, feelings, and sensations in the present moment. Borkovec et al. (2004)