as a form of therapy, cognitive behavioral therapy (cbt) is more than a mere “toolbox.” cbt allows us to better understand how the human mind is functioning because it is based on neuroscience and experimental and scientific psychology. previously, gad had been considered an “anxiety neurosis.” its specification as a singular disorder has allowed the recognition of factors common to anxiety disorders, for example, anxious anticipation, cognitive biases, and excessive concern. anxiety is almost always present in the minds of patients. barlow’s model15 describes a biological and psychological vulnerability to the negative elements of life.
it is fundamental to explore and evaluate the beliefs about the function of concerns. it makes it possible to visualize the mental functioning of the person, which is already therapeutic in and of itself. it is also possible to evaluate the consequences of worry and to understand subtle avoidance. always considering the “what if?” they ask a lot of questions to be sure and certain and sometimes they try to predict every possible scenario.
generalized anxiety disorder (gad) is a common and disabling condition with the hallmark symptom of persistent, excessive, and uncontrollable worry across a number of different topics (1). cbt for gad demonstrated large effects for pre-to-posttreatment reduction of anxiety and depression symptoms that were broadly in line with the comparison efficacy trials selected by the authors of the meta-analysis (22, 37, 38). the following evaluation focuses on disorder-specific and generic outcomes of a cbt intervention designed to target key cognitive-process maintaining pathological worry in gad provided in a uk national health service (nhs) clinical service. hirsch and mathews’ (41) model of worry posits a key role for negative interpretations in triggering negative thoughts and maintaining worry. hence, negative interpretation bias has a causal role in maintaining worry and anxiety in people with gad in the longer term. in the control condition participants were asked to listen to the positive stories for half of the story pairs, and worry stories for the other half. individuals with gad may struggle to interrupt streams of worry and refocus onto other topics since worry occupies the same limited attentional control resources needed to refocus attention elsewhere. borkovec and sharpless (80) also highlight the need to focus on processes that appear particularly effective in reducing uncontrollable worry in gad. change in worry and anxiety were the primary outcomes, as the treatment focused on disorder-specific processes in gad. focusing the session can therefore be challenging and therapists may be drawn into “firefighting” individual worries, rather than seeing cbt as a means to develop more benign cognitive processes that can reduce worry in general. the challenge for redeploying the “mental spotlight” is that the “mental magnet” of worry tends to keep the “mental spotlight” focused on worry. in our adaptation of the techniques, clients are also asked to specify the concrete and specific feared outcome of the worry by briefly describing how a film director would set up the scene to show this outcome. introducing the concept of attentional control as a mental spotlight that can be difficult to shift and introducing cbt techniques as a way of developing new “mental muscles” that require numerous repetitions to develop helps to address potential barriers to progress with cbt. wfz were first introduced by borkovec and sharpless (80) but have been adapted to highlight the role of cognitive processes that maintain worry. it also has the function of getting the client to be a “detective for positive outcomes” and thus helps develop a more benign attentional bias. reliable change rates were computed for the pswq, gad-7, and phq-9 to assess the clinical significance of change across treatment. the current service audit aimed to investigate the effectiveness of cbt for gad that was adapted to maximize potential impact on key processes which maintain worry, based on an evidence-based cognitive-process model of pathological worry. that said, the rates are in keeping with gold standard trials of cbt for gad, and thus this is also an issue for the field more generally.
due to the preliminary nature of this evaluation and data availability, medication status and other potentially relevant clinical and demographic factors were not controlled for in the analyses. formal evaluation of cbt for gad guided by a cognitive process view of gad in the form of a full randomized control trial is consequently indicated to continue to strengthen client outcome for this common and debilitating condition. the epidemiology of worry and generalized anxiety disorder. quality of life in the anxiety disorders: a meta-analytic review. humanistic and economic burden of generalized anxiety disorder in north america and europe. a new theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting an avoidance of a negative emotional contrast. a meta-analysis of cognitive therapy for worry in generalized anxiety disorder. doi: 10.1037/a0016032 37. borkovec td, costello e. efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. doi: 10.1016/0146-6402(83)90015-2 44. hirsch cr, meeten f, krahé c, reeder c. resolving ambiguity in emotional disorders: the nature and role of interpretation biases. doi: 10.1037/a0013473 50. hayes s, hirsch cr, krebs g, mathews a. the effects of modifying interpretation bias on worry in generalized anxiety disorder. doi: 10.1177/2167702614545216 59. borkovec td, inz j. the nature of worry in generalized anxiety disorder: a predominance of thought activity. doi: 10.1016/j.mppsy.2007.01.005 68. hirsch cr, perman g, hayes s, eagleson c, mathews a. delineating the role of negative verbal thinking in promoting worry, perceived threat, and anxiety. the unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. doi: 10.1037/a0012908 78. zainal nh, newman mg. executive function and other cognitive deficits are distal risk factors of generalized anxiety disorder 9 years later. the role of positive beliefs about worry in generalized anxiety disorder and its treatment. the effectiveness of cognitive behavioral therapy for generalized anxiety disorder in a frontline service setting. doi: 10.1016/j.brat.2012.10.003 98. arntz a. cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
cbt is an effective treatment for gad, typically leading to reductions in worry, and a study has shown that such therapy is equal to pharmaceutical cognitive behavior therapy (cbt) is recommended as the first-line treatment for gad; however, further investigation into its effectiveness in the therapies can be conducted individually or with a group, and cbt is helpful for older adults with gad as well. typically, cbt will be conducted in weekly, .
the treatment of choice for generalized anxiety disorder (gad) is cognitive behavioral therapy (cbt). research has shown cbt is significantly more effective in this video, anxiety disorder specialist, dr. vincent cognitive behavioral therapy is a well researched, highly effective treatment option for those suffering from generalized anxiety disorder, .
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