Article summary of Cognitive-behavioral therapy for generalized anxiety by Borza - Chapter

What is generalized anxiety disorder (GAD)?

Generalized anxiety disorder (GAD) affects about 6% of the population and is characterized by excessive worry about various topics, and an inability to tolerate uncertainty. This worry has to occur more often than not over a time period of at least 6 months in order to get a diagnosis. Often, the worries that people with GAD experience are simply much more intense versions of the same worries that the general population grapples with. People with GAD may also have issues with sleeping and restlessness or concentration difficulties. Another core symptom in GAD is the constant searching for reassurance. Comorbidities with GAD are very common — about 66% of patients with the disorder present with at least one other psychopathology. It is estimated that about 90% of people with GAD suffer from at least one additional anxiety disorder. The diagnosis has evolved quite a bit over the last 20 years, and it is expected that GAD will become a more specific and individualized disorder in the coming years. 

How can GAD be represented through various models? 

Barlow’s model refers to the psychological vulnerability that sufferers of GAD have to adverse life events. This theory posits that people with GAD focus on potential threats in their lives and perceive a loss of control over their life. The model of intolerance of uncertainty postulates that people with clinical anxiety have difficulty coming to terms with the potential negative outcomes of future events. These individuals create positive beliefs about their worries; they may believe that if they do not suffer any consequences of a particular event that their worries have “worked”. Some of these chronic worriers tell themselves that an accident is more likely to happen if they stop worrying. This coping strategy will not work in their favor — the worry will always come back. 

What are some interventions for GAD? 

With functional analysis, clinicians can get a good idea of how, when, and why an anxious response is triggered in a patient with GAD. This method makes it easier for the therapist to understand the patient’s cognitions and mental state. Psychoeducation is also a common and effective tool. This entails educating patients about therapeutic instruments that can be used to help them and has been found to increase patients’ motivations to improve their symptoms. In the emotional/behavioral approach, the patient is taught how to generate positive emotions. They will also be given the chance to be exposed to their own emotions, which should help to habituate them. Through exposure, patients should be able to better process and tolerate their own fears. The cognitive perspective emphasizes recognizing thoughts and discerning them from emotions. This therapy method also focuses on altering the patient’s thoughts to be more objective and less emotional and less subject to cognitive biases.