422 TREATMENT OF SPECIFIC ANXIETY DISORDERS
with her employees and more distressed and irritable at home. However, she appraised
her worries about her preschool daughter’s safety more positively, thinking this worry
caused her to be a more cautious mother and so reduced the risk of injury for her
child. As discussed below, the perceived consequences of worry are a primary target for
change in cognitive therapy of GAD.
Worry Control Strategies
As indicated in the cognitive model of GAD (Figure 10.1), attempts to suppress or con-
trol worry will contribute to its persistence because the ineffectiveness of these strategies
confirms the individual’s belief that the worry is dangerous and uncontrollable. Thus it
is critical to assess the frequency, type, and perceived effectiveness of the various thought
control strategies employed with each primary worry concern. Table 10.3 presents a list
of positive and negative worry control strategies based on the empirical literature.
In addition to interview questions about worry control strategies, the cognitive
therapist can use the Cognitive Response to Anxiety Checklist in Chapter 5 (Appendix
5.9) to assess the client’s use of thought control strategies. The wording of Appendix 5.9
should be changed from “anxious thinking” to “worrisome thinking.” Furthermore, the
clinician will want to determine the positive and negative control strategies used with
each primary worry concern and obtain information on how frequently it is employed
as well as its perceived effectiveness.
Safety Scripts and Problem Orientation
Individuals with GAD should be asked to describe what would give them a sense of
peace or safety in a particular worry domain—that is, to write out a script of how a
table 10.3. Worry Control strategies in generalized anxiety Disorder
Negative control strategies
••Directed suppression (i.e., “Tell myself not to worry”)
••Self-reassurance (i.e., “Tell myself everything will be okay”)
••Seek reassurance from others (i.e., ask family/friends if everything will be
alright)
••Checking (i.e., engage in some repetitive act to relieve doubt)
••Punishment (i.e., criticize self for worrying)
••Emotion suppression (i.e., try to suppress the distress, anxiety associated
with worry)Positive control strategies
••Directed expression (i.e., intentionally allow myself to worry, let it run its
course)
••Distraction (i.e., get involved in a distracting activity, or replace worry with
more positive thinking)
••Threat reappraisal (i.e., reappraise the imagined threat of the worry concern)
••Engage in problem solving (i.e., develop an action plan for dealing with the
worry concern)
••Relaxation (i.e., engage in meditation or relaxation)