Areas of Specialization - Adults

Managing Generalized Anxiety and Chronic Worry Treatment

What is cognitive behavioral therapy for Generalized Anxiety Disorder?

Cognitive behavioral therapy of Generalized Anxiety Disorder is based upon the theory that people with GAD constantly perceive the world as a dangerous place and respond with maladaptive and habitual thoughts, behaviors and physiological responses that maintain this danger laden view of life. Maladaptive cognitive responses include unwarranted vigilance to possible threats in their environment, catastrophic thinking, overestimating the probability of adverse outcomes, and an avoidance of conceptualizing problems in a solvable manner. Unhelpful behavioral responses involve avoidance of situations that may provoke anxiety or other negative emotions, slowed decision making, and ineffective problem solving. The negative physiological responses entail excessive muscle tension and overarousal. The interaction of these cognitive, behavioral and physiological responses leads to intensified anxiety and distress. Cognitive behavioral therapy focuses on replacing these maladaptive reactions with multiple adaptive coping responses that specifically target each domain of dysfunction.

Behavior therapy concentrates on altering specific actions and responses through employing several techniques to decrease or stop unwanted behavior and increase desired behavior. The first technique taught is self-monitoring. The client learns to pay attention to any shift in their anxiety level and to notice interactive patterns of catastrophic thinking, physiological activity, behavioral avoidance, and the situations that may trigger these responses. As the client becomes increasingly aware of the triggers to their anxiety, they are taught to use newly learned anxiety management skills to lessen their discomfort and distress. These skills include diaphragmatic breathing, a special breathing exercise involving slow, deep breaths to reduce anxiety and the tendency to hyperventilate. Progressive muscle relaxation, involving the sequential tightening and relaxation of muscle groups in the body, is also taught as a means of alleviating physical tension and headaches.

Another behavioral technique is gradually helping the client confront what cause them to worry. The client begins with ranking distressing situations from the least to the most anxiety provoking and identifying their exact feared outcome. Through gradual and guided exposure, the client confronts feared situations and activities by using newly learned coping techniques. Thus, the client acquires an increased sense of competence and mastery that ultimately modifies the manner in which they experience their previously feared situations. Cognitive therapy teaches clients to understand how their thinking patterns contribute to their symptoms and how to change their thoughts so that anxiety is less likely to occur. Clients learn to identify catastrophic thoughts, challenge any probability overestimations of negative outcomes, and control the amount of time spent worrying through structured "worry" exposures.

Cognitive therapy techniques include identification of negative automatic thoughts, logical analysis of one's beliefs based on probability and evidence, development of multiple alternative perspectives other than the "danger laden world" view, behavioral testing of predictions, and decatastrophizing.

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