260 CHAPTER 7
Cognitive Methods
Cognitive methods for treating GAD focus on fi rst helping patients to identify the
thought patterns that are associated with their worries and anxieties and then help-
ing them to use cognitive restructuring and other methods to prevent these thought
patterns from spiraling out of control. The methods can also decrease the inten-
sity of patients’ responses to their thought patterns, so that they are less likely to
develop symptoms. Specifi c cognitive methods include the following:- Psychoeducation about the nature of worrying and GAD symptoms and available
treatment options and their possible advantages and disadvantages. - Meditation, which helps patients learn to “let go” of thoughts and reduce the
time spent thinking about worries (Evans et al., 2008; Lehrer & Woolfolk, 1994;
Miller, Fletcher, & Kabat-Zinn, 1995). - Self-monitoring, which helps patients become aware of cues that lead to anxiety
and worry. For instance, patients may be asked to complete a daily log about their
worries, identifying events or stimuli that lead them to worry more or worry less. - Problem solving, which involves teaching the patient to think about worries in very
specifi c terms—rather than global ones—so that they can be addressed through
cognitive restructuring. Here’s an exchange between a therapist and a patient with
GAD. The patient starts out talking about a night when sleep had been particularly
elusive; the phone had rung at 11:30 p. m., but it was a wrong number. Near the
end of the exchange, the therapist tries to engage the patient in problem solving.
Therapist: What did you think the call might be about?
Patient: Well, you know, bad news of some sort, someone dying or something like
that. After my visit home this summer, I have often worried that my father
is getting up there in years, he turned 55 in July, and, well, since I moved to
Albany I haven’t seen my folks nearly as much as I would have liked to.
Therapist: So, when the phone rang, you were worried that something may have hap-
pened with your father?
Patient: I don’t think just then because I picked up the phone real fast, but the phone
ringing kind of startled me. But after I hung up, I wondered why I was so
anxious and I realized that I must have thought that something happened to
him. Once I realized that, I was worried about him the rest of the night.
Therapist: If I recall from what you said before, he’s in pretty good health, isn’t he?
Patient: Yeah, he had a mole removed a while ago. Since he’s worked outside all of his
life, I worry that all that sun will have caused him to get skin cancer some day.
Therapist: What do you picture happening if your dad did pass away? [Note: Therapist
attempts to help the patient frame the problem as a worst-case scenario;
patient and therapist can then engage in problem solving.]
Patient: What do you mean? Do you mean what would I do?
(Brown, O’Leary & Barlow, 1993, p. 159)
Cognitive• restructuring, which involves helping the patient learn to identify and shift
automatic, irrational thoughts related to worries (see the third panel in Figure 7.4).
With the patient concerned about his father’s health, the therapist could point out
that the patient is using catastrophic thinking as well as overestimating the prob-
ability that something dire will occur (Brown, O’Leary & Barlow, 1993).Targeting Social Factors
The neuropsychosocial approach leads us to notice whether certain kinds of treat-
ments are available for particular disorders. For instance, at present, there are very
few treatments for GAD that specifi cally target social factors.
Although CBT for GAD may be provided in a group format (Dugas et al.,
2003), such groups seek to change thoughts, behaviors, and feelings; they do not
directly focus on changing relationships, family dynamics, or other social factors.
Similarly, family or couples therapy may be employed, but such treatment is usually
a supplement to the primary treatment of medication or CBT.