Cognitive-Behavioral Treatment for Generalized Anxiety Disorder

Course Outline

The Practical Clinical Guidebooks Series provides clinicians, students, and trainees with clear descriptions of practical, empirically supported treatments for specific disorders and their sequelae.

Recent studies have shown that generalized anxiety disorder (GAD) is a common dis-order, affecting between 2% and 4% of the population at a given time. And, contrarary to previously held assumptions, if not properly diagnosed and treated, GAD can lead to considerable distress and impairment, which often develop into substantial personal,social, and financial costs.

Fortunately, medical understanding of the nature and treatment of GAD has dramatically increased over the past 15 years. Cognitive-Behavioral Treatment for Generalized Anxiety Disorder presents a comprehensive analysis of the etiology, assessment, and treatment of GAD, focusing on an evidence-based cognitive model developed by the authors’ clinical research team. In this guidebook, Dugas and Robichaud first discuss the empirical support for this tailored cognitive-behavior therapy (CBT) approach, providing the groundwork for the complete overview and detailed step-by-step treatment guide which follow. The volume concludes with sections on treatment efficacy in both individual and group therapy and clinical strategies for addressing common complicating factors in diagnosis and treatment, such as comorbidity, low client motivation, and issues with medication and managed care. This guidebook provides the practitioner or clinician-in-training with a practical, evidence-based approach for the successful assessment, diagnosis, treatment, and management of generalized anxiety disorder.

About the Authors

Michel J. Dugas, Ph.D.,is Associate Professor and Director of the Anxiety Disorders Laboratory in the Department of Psychology at Concordia University. He also works as a clinical psychologist at the Anxiety Disorders Clinic of Sacre’-Coeur Hospital in Montreal and is past-Chair of the Clinical Section of the Canadian Psychological Association. Over the past 15 years, Dr. Dugas has conducted research on the etiology and treatment of GAD and other anxiety disorders.

Melisa Robichaud, Ph.D.,works as a psychologist in the Anxiety Disorders Clinic of UBC Hospital in Vancouver, British Columbia. She specializes in cognitive-behavioral research and treatment for anxiety disorders, with an emphasis on generalized anxiety disorder and obsessive-compulsive disorder. She has published in the areas of anxiety, worry and problem solving, and serves on the board of directors for the Anxiety Disorders Association of British Columbia.

Learning Objectives

After completing this course you’ll be able to:

1. Discuss GAD as defined in the DSM-IV in 1994.
2. Describe the walking wounded
3. Describe the clinical picture of GAD.
4. State the prevalence of GAD in the general and clinical picture.
5. Discuss GAD as related to onset, course, remission, and gender differences.
6. Discuss research on comorbidity.
7. Discuss direct and indirect costs of GAD.
8. Discuss intolerance of uncertainty.
9. Discuss positive beliefs about worry.
10. Discuss negative problem orientation.
11. Describe enhancement effects.
12. Discuss excessive worry and somatic symptoms of GAD.
13. Discuss impairment and distress in the individual with GAD.
14. List several obstacles to diagnosing GAD.
15. Describe several differential diagnosis.
16. Compare advantages and disadvantages of a structured interview.
17. State why self-report questionnaires are useful and give examples.
18. State the goal of cognitive-behavioral treatment.
19. Describe Module 1: Psychoeducation and Worry Awareness Training.
20. Describe Module 2: Uncertainty Recognition and Behavioral Exposure.
21. Describe Module 3: Reevaluation of the Usefulness of Worry.
22. Describe Module 4: Problem-Solving Training.
23. Describe Module 5: Imaginal Exposure.
24. Describe Module 6: Relapse Prevention.
25. Discuss negative problem orientation as described in Module 4.
26. List the three guidelines for attaining a goal according to Module 4.
27. List advantages and disadvantages of statistical comparison of mean effects.
28. Describe briefly the four Cognitive-Behavioral Therapy and Wait-List Control studies.
29. List several client complicating factors.
30. List several therapist complicating factors.
31. List contextual complicating factors.

Course Contents

1. Description of Generalized Anxiety Disorder
    Diagnosis of GAD
    Clinical Picture: What Does GAD Look Like?
    The Cost of GAD
2. A Cognitive Model of Generalized Anxiety Disorder
    Intolerance of Uncertainty
    Positive Beliefs about Worry
    Negative Problem Orientation
    Cognitive Avoidance
    Connections between Model Components
    Clinical Implications of the Model
3. Diagnosis and Assessment
    The Clinical Interview
    Obstacles to the Diagnosis of GAD
    Differential Diagnosis
    Structured Diagnostic Interviews.
    Self-Report Questionnaires
    Appendix 3.1 Worry and Anxiety Questionnaire (WAC)
    Summary and Concluding Remarks
    Appendix 3.2 Penn State Worry Questionnaire (PSWC)
    Appendix 3.3 Intolerance of Uncertainty Scale (IUS)
    Appendix 3.4 Why Worry II (WW-II)
    Appendix 3.5 Negative Problem Orientation Questionnaire (NPOQ)
    Appendix 3.6 Cognitive Avoidance Questionnaire (CAQ)
4. Treatment Overview
    Treatment Outline
    Module 1: Psychoeducation and Worry Awareness Training
    Module 2: Uncertainty Recognition and Behavioral Exposure
    Module 3: Reevaluation of the Usefulness of Worry
    Module 4: Problem-Solving Training
    Module 5: Imaginal Exposure
    Module 6: Relapse Prevention
    Summary and Concluding Remarks
5. Step-by-Step Treatment
    Module 1: Psychoeducation and Worry Awareness Training
    Module 2: Uncertainty Recognition and Behavioral Exposure
    Module 3: Reevaluation of the Usefulness of Worry
    Module 4: Problem-Solving Training
    Module 5: Imaginal Exposure
    Module 6: Relapse Prevention
    Appendix 5.1 Model 1: The Symptoms Associated with GAD
    Appendix 5.2 Handout for Model 1: Worry Diary Form
    Appendix 5.3 Model 2: The Role of Intolerance of Uncertainty
    Appendix 5.4 Handout for Model 2: Uncertainty and Behavior Monitoring Form
    Appendix 5.5 Model 3: The Role of Positive Beliefs about Worry
    Appendix 5.6 Handout for Model 3: Handout for Positive Beliefs about Worry
    Appendix 5.7 Model 4: The Role of Negative Problem Orientation
    Appendix 5.8 Handout for Model 4: Resolution of a Problem Form
    Appendix 5.9 Model 5: The Role of Cognitive Avoidance
    Appendix 5.10 Handout 1 for Model 5: Scenario for Exposure Form
    Appendix 5.11 Handout 2 for Model 5: Exposure Summary Form
    Appendix 5.12 Model 6: The Influence of Mood State and Life Events
6. Treatment Efficacy
    Criteria for Establishing Treatment Efficacy
    Studies of Treatment Efficacy
    General Conclusions
7. Addressing Complicating Factors
    Client Complicating Factors
    Therapist Complicating Factors
    Contextual Complicating Factors
    Concluding Remarks

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