Behavioral Therapy to Treat Generalized Anxiety Disorder (GAD)
Anxiety and excessive worrying are symptoms of generalized anxiety disorder (GAD). In this regard, Dugas and Ladouceur pointed out that people with GAD are more concerned about mindless circumstances.
People with generalized anxiety disorder worry about things that may not happen and are always on high alert. Therefore, they have more anxiety, have difficulty controlling their emotions, and always want to control their thoughts.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) combines Beck’s therapy and relaxation techniques. Clinical research confirms that CBT and relaxation techniques help treat GAD.
Generic cognitive behavioral therapy consists of:
- Determining internal and external factors that cause anxiety and how people react to them.
- Controlling these factors to avoid worries.
- Relaxation. There are different techniques such as progressive relaxation, slow breathing, and meditation.
- Cognitive restructuring. The patient identifies thoughts, images, and beliefs associated with anxiety. Then, the Socratic method is used to examine the pros and cons and to interpret these feelings.
- Gradually exposing the patient to internal factors that cause anxiety. This can teach the patient to handle their anxiety properly.
Borkovec’s Cognitive-Behavioral Therapy for Generalized Anxiety Disorder
Borkovec’s CBT includes all the elements from generic CBT and includes two others: acceptance and commitment.
- Minimize negative thoughts. The idea is to live in the present without creating false expectations about the future.
- Living according to values. Identifying the patient’s values to help them live according to them.
Barlow’s Therapy
Brown, O’Leary, and Barlow developed a treatment for GAD that consists of identifying the problem, justifying treatment, relaxation, cognitive restructuring, exposure therapy, preventing alertness, and time management.
- Relaxation. Based on Borkovec’s progressive relaxation. However, any other technique can be used.
- Cognitive restructuring. Explaining concepts such as negative thoughts, how they’re influenced by what’s happening in the present, and how these interpretations and predictions can impact the patient’s life. In addition, you have to identify these predictions and interpretations to question them later on.
- Preventing alertness. The patient needs to stop being on high alert at all times.
- Time management. Teaching the patient how to set goals and manage their time.
- Problem-solving. Problem-solving makes identifying problems easier.
This intervention can last from 12 to 15 one-hour individual weekly sessions.
Some modern versions of this treatment include assertiveness treatment, interrupting medication, and involving the patient’s family.
Dugas’ Approach
Dugas’ team proposes another type of GAD treatment that consists of:
- Psychoeducation and realization treatment. To differentiate realistic and unrealistic worries.
- Is it useful to be worried? The patient usually overestimates the perks of worrying, while underestimating the negative consequences of doing so.
- Problem-solving. To stop worrying about current issues, problem-solving is advised. Teaching patients how to solve their problems consists of problem orientation and problem-solving skills.
- Exposure therapy. Showing the patient that avoiding their thoughts is counterproductive.
2007 revisions
- Recognizing uncertainty and behavioral exposition. This module strives to help the patient stop worrying excessively.
- Relapse prevention. The therapist revises with the patient all the things they learned and reminds them to keep practicing.
Finally, the patient is encouraged to develop an action plan before therapy ends. They have to set goals for themselves so they can keep progressing without the therapist’s help.
Metacognitive Therapy
Wells suggested that generalized anxiety disorder treatment needs to focus on the patient’s worries. It’s about the “style” of these worries, not the content. This type of intervention consists of:
- Individual functional analysis.
- Educating the patient on identifying two types of beliefs: negative beliefs about worrying and dysfunctional beliefs about how useful they are.
- Verbal reconstruction and behavioral experiments.
- Eliminating negative strategies. An example of this is trying to control thoughts, defensive behavior, and avoidance. All these strategies interfere with self-regulation processes and sustain GAD.
- End of treatment. Revising all strategies.
Worrying is a warning sign. The way that your concerns are triggered has a lot to with your ability to interpret reality and the information you perceive. When this alarm system doesn’t work properly, excess worrying can lead to suffering.