Generalized Anxiety Disorder 419
Primary Worry Content
Although current concerns and internal/external triggers are antecedents to worry, it is
more practical to begin by assessing the client’s primary worries and associated anxious
symptoms. Information from the ADIS-IV as well as any worry content questionnaires
that might be administered, such as the WDQ, will provide the first clues about the cli-
ent’s worries. However, daily monitoring of worry activity and a more detailed clinical
interview will be needed to obtain a full understanding of the client’s worry concerns.
Appendix 10.1 provides a Worry Self- Monitoring Form B that can be used to col-
lect critical information on individuals’ primary worry content. Chapter 5 (Appendix
5.8) presents an alternative worry form that can be used if less detailed information is
required. We suggest that Appendix 5.8 be used for non-GAD worry and that Appendix
10.1 be used with GAD clients. There are a number of features of worry content that
should be assessed from the self- monitoring form and clinical interview.
- What is the range or extent of the client’s worries?
- What are the frequency, intensity, and duration of the worry episodes?
- What is the level of anxiety or distress associated with each worry topic? What
symptoms of anxiety are experienced during worry? - What is the worst outcome or catastrophe that underlies each worry topic? What
is the client’s estimate of the probability or likelihood of the catastrophic out-
come? - If the worst outcome is rated as highly unlikely, what does the client perceive as
the most likely negative outcome? - If more than one primary worry content is present, rank-order the worries from
most important/disturbing to least important/disturbing. Determine which
worry topic the client would choose for focus of therapy.
In our case illustration Rebecca expressed a number of worry concerns: worries
about her parent’s health, her own health, her children’s safety, family finances, and
her work performance. Assessment of worry frequency, duration, and associated dis-
tress indicated that her performance at work and her own health were the most dis-
tressing worries. She selected her work performance as the most important topic for
therapy. When we explored these worries further, she indicated that the catastrophe
associated with this worry was of being reprimanded by her supervisors for mishan-
dling an employee problem. This could result in litigation against her, but the greatest
consequence is that she would loose the respect of her employees and be seen within the
company as a weak and inadequate leader. Interestingly, her worry had a more social
focus that subsequently guided cognitive restructuring of this worry issue. It is always
important to determine the catastrophizing process associated with each worry.
Personal Goals and Current Concerns
In order to understand the personal context of worry, the cognitive therapist must appre-
ciate the client’s immediate and long-term personal goals, strivings, and ambitions. This
information should become apparent from the clinical interview but a few direct ques-
tions may be needed as well. The therapist can ask the client to indicate her immediate