Cognitive Therapy of Anxiety Disorders

Generalized Anxiety Disorder 425

very demanding life, there’s a lot to worry about,” “I’m a highly anxious person and this
causes me to worry,” “I have a chemical imbalance that makes me worry too much,”
and so on. The therapist should follow up by asking, “What do you think is the solution
to your worry, the best way to treat worry?” Again the client may generate a number of
ideas such as find a way to resolve the worry concerns or situations, learn to relax, take
medication to reduce anxiety, reduce stress, and the like. The therapist could also ask,
“over the years has your anxiety and worry fluctuated at all? If so, have you noticed
what makes the worry better or worse?”
After assessing the client’s personal theory of anxiety and worry, the therapist is in
a better position to determine whether she will be receptive to socialization into the cog-
nitive model of worry. If the client holds strong beliefs about anxiety and worry that are
incompatible with the cognitive perspective, these beliefs must be targeted for change
before proceeding with cognitive treatment of worry. There are five main elements of the
cognitive model that should be communicated to the client:

table 10.4. treatment goals for Cognitive therapy of generalized anxiety Disorder

••Normalize worry

••Correct biased threat beliefs and interpretations of worry concerns

••Modify positive and negative metacognitive beliefs about worry

••Eliminate meta-worry (i.e., worry about worry)

••Reduce reliance on dysfunctional worry control strategies and promote adaptive

control responses to worry

••Improve confidence in problem-solving ability

••Increase perceived control over worry

••Enhance a sense of safety and self-confidence to deal with future challenges

••Accept risk and tolerate uncertain outcome of future situations and events

••Increase tolerance of negative emotion

table 10.5. treatment Components in Cognitive therapy for generalized anxiety Disorder

••Educate on the cognitive perspective of worry

••Distinguish between productive and unproductive worry (see Leahy, 2005)

••Cognitive restructuring and empirical hypothesis testing of biased threat appraisals and

beliefs about worry

••Worry induction and decatastrophizing (Craske & Barlow, 2006)

••Repeated worry expression with response prevention of ineffective worry control

strategies (Borkovec et al., 2004)

••Self-directed effortful processing of safety cues

••Cognitive restructuring of negative metacognitive beliefs about worry (Wells, 2006)

••Risk and uncertainty inoculation

••Constructive problem-solving training

••Elaborative processing of the present (Borkovec et al., 2004)

••Relaxation training (optional)