Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice (Practical Clinical Guidebooks) by Michel J. Dugas & Melisa Robichaud

Author:Michel J. Dugas & Melisa Robichaud [Dugas, Michel J.]
Language: eng
Format: azw3
Publisher: Taylor and Francis
Published: 2012-10-11T16:00:00+00:00

Worry Awareness Training

Once the first model has been presented (and the importance of worry underscored), the next phase is introduced; namely, worry awareness training. As mentioned beforehand, one must first clearly “see” a symptom before attempting to reduce it. In the case of GAD, it is important that clients become experts at recognizing their own worries and classifying them as either being about a current problem or a hypothetical situation. Given that some clients feel that they already think too much about their worries, the therapist will occasionally encounter some “resistance” when asking clients to systematically monitor their worries. However, once clients begin worry awareness training, they typically realize within a short period of time how important and helpful this training can be. As such, worry awareness training is the first between-session exercise “prescribed” by the therapist.

Clients are asked to record their worries three times a day, at predetermined times, in their Worry Diary (see Appendix 5.2 for a copy of the Worry Diary). Specifically, clients record the date and time the worry occurred, the description of the worry, their level of anxiety at that time (on a scale from 0 to 8), and the worry type (about a current problem or a hypothetical situation). Once clients have completed the between-session exercise, the therapist should ask what they discovered about their worries as a result of filling out the diary. In a Socratic fashion and using client examples of worries, the following points should be covered:

• Clients usually have recurrent worry themes. Although most will say that they worry about “everything,” most clients will have a few worry themes that consistently recur.

• A worry chain can last a few minutes or a few hours. Since the goal of treatment is not to eliminate worry, but rather to reduce it to more manageable levels, clients need to see just how much of their time is being consumed by worry. In addition, seeing how one worry can lead to others shows the pernicious cycle of worry chains.

• Worries involve future events. Even when a worry is rooted in a past event (e.g., failing an exam a week ago), it is typically about the future repercussions of the past event (e.g., “How will this affect my grade point average at the end of term?”).

• Worries can involve both a current problem and a hypothetical situation. A client can be worried about chronic pain (which is a current problem) and also be worried that the pain is a sign that he or she may have a serious illness such as cancer in the future (which is a hypothetical situation). This is usually the result of a worry chain, where a client begins worrying about a topic, for example chronic pain, which leads to worrying about other things, such as cancer.

Although it is important to ensure that clients properly understand the distinction between both types of worry, care must be taken when expanding on this topic. Given that GAD clients are prone to reassurance seeking

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