Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)
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Introduction & Theoretical Background
Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Other common symptoms include restlessness, physical arousal, difficulty concentrating, muscle tension, and poor sleep. Early psychological models of GAD conceptualized the anxiety in relatively generic cognitive terms of an individual’s heightened preoccupation with danger and underestimation of their ability to cope, or describing worry as a failed attempt at problem-solving (e.g. Butler et al, 1987; Borkovec et al, 1993; Roemer, Orsillo, Barlow, 2002). Treatments derived from these models had limits to their effectiveness, with GAD being described as “largely impervious to traditional cognitive restructuring approaches” (Hebert & Dugas, 2019). Confusingly, many people struggling with GAD reported high levels of threat even in the absence of objective risk, difficulties, or danger (Milne, Lomax & Freeston, 2019).
Dugas, Gagnon, Ladouceur & Freeston’s cognitive-behavioral model of GAD, published in 1998, gave a central
Therapist Guidance
“Many people’s anxiety fits the pattern on this diagram. I wonder if we could explore some of your thoughts, feelings, and reactions and see what kind of pattern they follow?”
- Psychoeducation. Introduce the concepts of uncertainty (situations where you don’t know the outcome) and intolerance of uncertainty (more than just a dislike of uncertainty: “almost as if you have a ‘psychological allergy’ in which a small amount of uncertainty produces a powerful reaction”). “Do these descriptions sound like they related to you at all?”, “Can you identify with having strong reactions to uncertainty?”
- Explore the client’s typical triggers for - and reactions to - uncertainty. Common triggers for uncertainty are novel, ambiguous, or unpredictable situations. “Can you give me some examples of uncertain situations that bother you?" (The therapist can notice qualities of novelty, ambiguity, or unpredictability), “How do you typically feel in situations that are unpredictable?", "Can you
References And Further Reading
- Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30-43.
- Clark, D. M. (1986). A cognitive approach to panic. Behavior Research and Therapy, 24(4), 461-470.
- Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behavior Research and Therapy, 36(2), 215-226.
- Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry?. Personality and Individual Differences, 17(6), 791-802.
- Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436.
- Roemer, L., Orsillo, S. M., & Barlow, D. H. (2002). Generalized Anxiety Disorder. In Anxiety and its disorders. David Barlow (Ed). New York: The Guilford Press.Salkovskis, P. M., Forrester, E., &