Generalized Anxiety Disorder: The CBT Approach
Summary
TLDRIn this video, Vince Greenwood, the director of the Washington Center for Cognitive Therapy, discusses Generalized Anxiety Disorder (GAD), a diagnosable condition characterized by excessive worry and physical symptoms. He outlines the components of GAD, including distorted thinking patterns, physical sensations, and behaviors like avoidance and reassurance seeking. Greenwood then describes the cognitive-behavioral treatment approach for GAD, which includes self-awareness, progressive muscle relaxation, and techniques to alter negative predictions and behaviors, aiming to reduce chronic worry and anxiety.
Takeaways
- 😀 Generalized Anxiety Disorder (GAD) is characterized by excessive worry and physical symptoms like muscle tension, restlessness, fatigue, irritability, and sleep difficulties.
- 😀 GAD is different from occasional worry; it is persistent, often daily for at least six months, and is a diagnosable condition.
- 😀 Key features of GAD include overestimating the probability of negative events and imagining worst-case scenarios (catastrophizing).
- 😀 Common beliefs in GAD sufferers include perfectionism, responsibility to focus on negative possibilities, and the idea that worry can prevent negative outcomes.
- 😀 The physical component of GAD involves symptoms like difficulty relaxing, trouble sleeping, irritability, and chronic over-arousal of the nervous system.
- 😀 Behavioral aspects of GAD include avoidance of perceived threats and reassurance-seeking behaviors, which reinforce worry.
- 😀 Cognitive Behavioral Therapy (CBT) is an effective, research-supported treatment for GAD, focusing on changing thoughts, behaviors, and physical responses.
- 😀 Self-monitoring and recording anxiety and worry states help identify specific components of GAD for targeted treatment.
- 😀 Progressive muscle relaxation is a key technique in CBT, helping reduce physical tension and break the cycle of worry.
- 😀 Challenging distorted thoughts and imagining coping with worst-case scenarios are effective CBT strategies to reduce worry.
- 😀 Addressing reassurance-seeking and avoidance behaviors is crucial in CBT to promote healthier coping mechanisms and reduce chronic worry.
Q & A
What is the Washington Center for Cognitive Therapy's area of specialization?
-The Washington Center for Cognitive Therapy specializes in the treatment of anxiety disorders.
What is Generalized Anxiety Disorder (GAD)?
-Generalized Anxiety Disorder (GAD) is a diagnosable condition characterized by excessive worry and a cluster of physical symptoms such as muscle tension, restlessness, fatigue, irritability, and sleep difficulties.
How does GAD differ from normal worry?
-GAD is different from normal worry in that it involves persistent, excessive worry that feels uncontrollable and is often accompanied by physical symptoms, whereas normal worry can be adaptive and help prepare for difficulties.
What are the three basic components of GAD?
-The three basic components of GAD are a thinking component (worrying), a feeling component (anxiety and apprehension along with physical symptoms), and a behavior component (avoidance and reassurance-seeking behaviors).
Why is it important to understand the components of GAD?
-Understanding the components of GAD is important because it makes the condition less mysterious, identifies specific areas for treatment, and helps to break the negative cycle of worry leading to physical tension and back to more worry.
What are the two key distortions in thinking that characterize GAD?
-The two key distortions in thinking that characterize GAD are overestimating the probability that something threatening might happen and catastrophizing, or overestimating the severity of an undesirable event.
What are the three beliefs associated with chronic worry in GAD?
-The three beliefs associated with chronic worry in GAD are perfectionism (the belief that one should not make mistakes), an inflated sense of responsibility (believing it's irresponsible not to focus on negative possibilities), and controllability (the belief that worry can prevent negative outcomes).
How does cognitive behavioral therapy (CBT) address the physical symptoms of GAD?
-CBT addresses the physical symptoms of GAD through techniques like progressive muscle relaxation, which helps to reduce tension and shift the body from a state of over arousal to a more relaxed state.
What is the purpose of self-monitoring during the initial stage of CBT for GAD?
-The purpose of self-monitoring is to help clients identify when, where, and under what circumstances they experience anxiety, as well as to pinpoint the specific thoughts, physical symptoms, and behaviors associated with their worry, which can then be targeted for treatment.
How does CBT help change the behavioral component of GAD?
-CBT helps change the behavioral component of GAD by targeting reassurance-seeking and avoidance behaviors, encouraging clients to engage in non-anxious behaviors, and teaching them to tolerate imperfection and let go of attempts to control everything.
What is the ultimate goal of CBT for treating GAD?
-The ultimate goal of CBT for treating GAD is to help individuals worry less, cope more effectively with problems, and reduce the self-defeating behaviors that contribute to their anxiety.
Outlines
🤔 Understanding Generalized Anxiety Disorder (GAD)
Vince Greenwood, the director of the Washington Center for Cognitive Therapy, introduces Generalized Anxiety Disorder (GAD) as a diagnosable condition characterized by excessive worry and physical symptoms like muscle tension and sleep difficulties. He emphasizes that GAD is more than normal worry and can significantly impact a person's life. The video aims to provide a clear understanding of GAD components, including thoughts, feelings, and behaviors, and to distinguish between everyday worry and GAD. The speaker also highlights the importance of recognizing when worry becomes a disorder and the persistent nature of a GAD sufferer's worries.
🔍 The Nature of Generalized Anxiety Disorder
This paragraph delves into the specifics of GAD, identifying its three main components: thinking, feeling, and behavior. The thinking component involves excessive worrying, the feeling component encompasses anxiety and apprehension along with physical symptoms, and the behavioral component includes avoidance and reassurance seeking. The paragraph explains how these components interact in a negative cycle, reinforcing each other. It also discusses the cognitive distortions prevalent in GAD, such as overestimating the probability and severity of negative events, and the beliefs that maintain worry, like perfectionism, responsibility, and controllability.
💪 The Physical Manifestations of Anxiety
The physical aspect of GAD is explored here, detailing symptoms like restlessness, difficulty relaxing, and irritability, which stem from the autonomic nervous system's response to perceived threats. The explanation includes the role of the sympathetic and parasympathetic branches of the autonomic nervous system, noting that individuals with GAD often have reduced parasympathetic control, leading to a constant state of heightened arousal. This paragraph also discusses the impact of these physical symptoms on daily life and the importance of addressing them in treatment.
🛠 Behavioral Components and Treatment Approaches for GAD
The behavioral elements of GAD are highlighted, such as difficulty concentrating, restlessness, avoidance, and reassurance seeking. The paragraph then transitions into discussing the cognitive-behavioral treatment (CBT) approach for GAD, which includes developing new skills to alter negative predictions, think more realistically, and manage physical tension. The self-awareness or self-monitoring stage of treatment is introduced as the first step, where clients monitor their anxiety and worry states to identify triggers and patterns, setting the foundation for targeted treatment.
🧘♂️ Progressive Muscle Relaxation as a Tool for Anxiety Management
This paragraph introduces progressive muscle relaxation as a technique to reduce physical tension associated with GAD. The process involves tensing and relaxing different muscle groups to develop the skill of shifting from a tense to a relaxed state. The benefits of this technique are explained, including breaking the cycle of tension and worry and providing a sense of control over anxiety. The paragraph outlines the training and application phases of learning this skill, emphasizing the importance of practice and gradual reduction of muscle groups to achieve a more efficient relaxation technique.
🤯 Challenging Excessive Worry and Cognitive Distortions
The focus shifts to addressing the thinking component of GAD, specifically the excessive worry that is difficult to control. Techniques for identifying, questioning, and disputing the thoughts that make up worry are discussed, targeting the overestimation of negative event likelihood and the tendency to catastrophize. The paragraph outlines a process of self-monitoring to identify specific worries, evaluating their real odds, and imagining more realistic outcomes. It also touches on the importance of picturing coping mechanisms for the imagined negative events to reduce the intensity of worry.
🚫 Addressing Reassurance Seeking and Avoidance Behaviors
The behavioral strategies for managing GAD are discussed, emphasizing the need to reduce reassurance seeking and avoidance behaviors that can reinforce worry. The paragraph explains how engaging in these behaviors can prevent individuals from challenging their anxious thoughts and learning that they can cope with negative outcomes. The goal is to replace these behaviors with non-anxious behaviors that promote tolerance for imperfection and a recognition of the humanness of making mistakes. The paragraph also suggests that behavior change is more effective after individuals have learned relaxation and realistic thinking skills.
🎯 Conclusion: The Efficacy of CBT for GAD
In conclusion, the paragraph summarizes the effectiveness of Cognitive Behavioral Therapy (CBT) in treating GAD by addressing the components of worry, physical tension, and self-defeating behaviors. It emphasizes the availability of research-tested treatment programs for those suffering from chronic worry and encourages individuals to seek help. The speaker reiterates the importance of treating GAD and the potential for individuals to gain control over their anxiety through targeted CBT techniques.
Mindmap
Keywords
💡Generalized Anxiety Disorder (GAD)
💡Cognitive Behavioral Therapy (CBT)
💡Worry
💡Anxiety
💡Catastrophizing
💡Physical Symptoms
💡Progressive Muscle Relaxation (PMR)
💡Self-Monitoring
💡Behavioral Component
💡Reassurance-Seeking Behavior
💡Avoidance
Highlights
Generalized Anxiety Disorder (GAD) is characterized by excessive worry and physical symptoms like muscle tension, restlessness, fatigue, irritability, and sleep difficulties.
GAD is a diagnosable condition that affects approximately 4% of the population and requires therapeutic attention.
Individuals with GAD perceive themselves as constant worriers, feeling stuck in a state of worry and physical tension.
Worry in GAD is persistent and different from the adaptive worry that helps prepare for difficulties.
GAD sufferers often live in a state of constant vigilance and apprehension, akin to 'walking in a war zone'.
The inability to turn off worry is a central feature of GAD, with significant worry occurring almost daily for at least six months.
GAD can be distinguished from normal worry by its excessiveness, persistence, and the impact on daily functioning.
GAD has three basic components: thinking (worrying), feeling (anxiety and apprehension), and behavior (avoidance and reassurance seeking).
Cognitive Behavioral Therapy (CBT) is an effective, research-supported treatment for GAD.
CBT helps individuals with GAD to develop new skills to alter negative predictions and manage physical tension.
Worry in GAD often involves 'distorted thinking', including overestimating the probability and severity of negative events.
Three key beliefs associated with chronic worry in GAD are perfectionism, responsibility, and controllability.
Progressive muscle relaxation is a tool in CBT that helps reduce physical tension and provides relief from the cycle of worry.
CBT techniques for the thinking component of GAD include identifying, questioning, and disputing the thoughts that make up worry.
Behavioral components of GAD, such as reassurance seeking, can be changed through CBT to build tolerance for imperfection and reduce avoidance.
The self-awareness or self-monitoring stage of CBT treatment helps clients identify the triggers and components of their anxiety.
CBT aims to help individuals with GAD to worry less, cope more effectively with problems, and improve overall quality of life.
Transcripts
hello my name is Vince Greenwood I am
the director of the Washington
Center for cognitive therapy a mental
health organization that specializes in
the treatment of anxiety disorders in
this video I am going to talk about
generalized anxiety disorder also
referred to as GA D generalized anxiety
disorder is a diagnoseable condition
characterized by excessive worry and a
cluster of physical symptoms such as
muscle tension restlessness fatigue
irritability and sleep difficulties over
the past few decades we have learned a
good deal about generalized anxiety
disorder and its treatment I am going to
describe the components of generalized
anxiety disorder the particular thoughts
feelings and behaviors that make up GA D
so that you have a clear more detailed
understanding of GA D and show how that
understanding has been utilized by
cognitive behavioral practitioners to
develop a highly effective research
supported treatment for generalized
anxiety disorder I am also going to
provide some guidelines and how you can
distinguish between a tendency to worry
and full-blown GA D first I'd like to
make the point that it is desirable and
appropriate the generalized anxiety
disorder is a diagnosable condition it
deserves that designation because GA D
is not just the tendency to worry or be
keyed up we all have the tendency to
worry from time to time to be keyed up
and feel tense indeed those tendencies
can be adaptive can help us prepare for
emerging difficulties however worried
intention
can be excessive and therefore deserving
of therapeutic attention research has
shown that generalized anxiety disorder
is a different animal altogether the
person with GA D would describe himself
as a constant warrior and those who knew
him well would agree with that
assessment his worries are persistent he
feels stuck in his worried state he
would also describe himself as stuck in
a state of physical tension he might
describe himself as uptight and tense
all the time
he is constantly vigilant and
apprehensive as one GA D sufferer put it
I feel like I'm always walking in a war
zone we are all familiar with the notion
of a cliffhanger as it applies to a
novel or a movie the cliffhanger
captures our attention it creates
tension in a good way for the story
however the world for the person with
generalized anxiety disorder as
reflected in their thoughts and worries
is like living from one cliffhanger to
the next but not in a good way they are
constantly besieged by thoughts such as
do I have enough money is there going to
be a school shooting in my community do
I need to develop more Skills to keep my
job might I be developing heart disease
did I say something stupid at the party
last night is the economy going to
collapse and on and on the world for the
GED sufferer often shrinks down to this
endless do loop of worries even if the
person with generalized anxiety disorder
a part of them anyway thinks their worry
is unreasonable or excessive they still
can't turn the worry off and that
inability to turn the worry off is a
central feature of GA D a major
diagnostic criteria for GA D is that
significant worry occurs almost every
day for at least six months
does worry tip from being helpful to not
helpful the following questions can help
flush out the tipping point for example
when I notice I am wrapped up and
worried and want to focus on something
else am I able to switch the worry off
are my worries extremely upsetting to me
make it difficult to get things done do
I worry so much that I am rarely able to
relax do I notice that I worry about
things that others worry about but in a
more exaggerated manner do I worry much
of the time without ever reaching a
possible solution for a particular
problem do I believe that if I don't
worry a terrible event will be more
likely to happen if your answer to a
number of these questions is yes you
might have generalized things our
anxiety disorder and might want to
examine the tendency to worry so much
generalized anxiety disorder can be a
torment for the person going through it
ga d certainly undermines peace of mind
it can get in a way of daily activities
and responsibilities it can get so
intense that the person has difficulty
functioning over time it can contribute
to physical health problems
approximately 4% of the population
struggles with generalized anxiety
disorder so is that what is the
particular nature of GA D this different
animal early on when researchers were
beginning to identify the particular
details of GA D they found it desirable
to think of GA D as having three basic
components a thinking component which
basically involves worrying a feeling
component which involves feelings of
anxiety and apprehension as well as
those physical symptoms I mentioned
earlier
and a behavior component behavior that
goes along with GA D includes avoiding
situations that the person worries about
were seeking reassurance about
situations that worries about breaking
generalized anxiety disorder down into
component parts has a number of benefits
many with GA D and those trying to help
them find the condition to be diffused
this pervasive tendency to worry in feel
tense but by pinpointing its specific
components we make the condition less
mysterious and identify the particular
components that then become targets for
treatment and change we have also
learned that these three components have
a dynamic relationship with one another
they reinforce one another and a kind of
negative cycle the more one worries the
more one feels tense which then leads to
avoidance behavior or reassurance
seeking behavior which often evokes more
worry and so on the flip side of this
cycle is that when we can effect a
positive change in one component the
thinking component worrying let's say
that tends to generate positive change
in the feeling and behavioral components
of GA D so let's go through the three
areas starting with a thinking or
worrying component first let's define
worry worry is usually defined as
focusing our thoughts on some kind of
threat that something undesirable is
happening or could happen now this can
be helpful at times but with GA d the
worry is excessive and counterproductive
to understand this 10 tendency we need
to understand the particular quality of
worry and those with GID
when we zero in on those with excessive
worry what do we see
research has enabled us to pinpoint to
fundamental ways of thinking which we
characterize as distorted thinking two
ways in which those with GA D interpret
life events the first distortion
involves overestimating the probability
that something threatening or
undesirable might happen for example a
person with GA D hearing a report that
the economy is not doing so well might
jump to the conclusion that they are
likely to lose their job
the second key distortion involves
overestimating the severity of the
undesirable thing happening a tendency
that has been labeled catastrophizing
for example the person who worries about
losing their job might view that
possibility not just as something
undesirable or quite stressful but is
having very damaging ruinous
unrecoverable impacts on their life or
family they imagine the worst case
scenario with chronic worriers it is not
so much what they worry about they tend
to worry about the same kinds of things
as those that are not chronic worriers
such as health concerns job or school
performance finances trying to be a good
friend or family member it's not what
they worry about but how they worry
specifically with these two distortions
the over estimation of the probability
and the over estimation of the severity
of some undesirable event the threshold
for worry is very low the person with GA
D always feels on high alert the danger
is lurking in addition we have also
identified three beliefs associated with
chronic worry these beliefs kind of
basic rules of the road reflect the GA D
sufferers attempt to ward off threats
but these beliefs end up just
reinforcing the worried State the first
believe his perfectionism the belief
that one cannot and should not make
mistakes and that to make mistakes in
judgment decision-making parenting work
or whatever represents incompetence in
managing life with this belief there is
the constant pressure to always make the
right judgment or display the perfect
behavior
the second belief relates to
responsibility that it is irresponsible
not to focus on negative possibilities
thus words that pop up in one's mind
should not be ignored and that worrying
means you are being responsible whereas
not worrying is to be irresponsible
the third key belief that we have
identified we label controllability the
belief that worry is a way of gaining
control and preventing negative outcomes
from coming true this is reflected in a
thoughts such as I am glad I worried
about my daughter because she made it
safely home from a trip these three
beliefs maintain the worry and anxiety
and help explain why chronic worriers
have such difficulty switching off their
worry and anxiety even though there is a
part of them that wants to switch it off
there is also a part of them that feels
that switching it off would be
irresponsible and might even increase
the possibility of some unwanted outcome
the good news is our detailed
understanding of these thinking errors
and beliefs that lead to chronic worry
have enabled us to design targeted
treatment strategies to counteract and
help those for whom worry has become to
seem so intractable the second component
of GA D is the physical component which
refers to the physical sensations or
symptoms such as restlessness
difficulty relaxing trouble falling
asleep or staying asleep usually due to
the mind racing also feeling easily
tired headaches gastrointestinal
difficulties and feeling irritable and
on edge these physical sensations are a
result of our brains sending a message
to our autonomic nervous system the
message sent is there's some kind of
threat and we need greater energy the
energy that goes along with our
fight-or-flight system we need that
energy to deal with the threat now let
me give just a brief description of how
our nervous system works the autonomic
nervous system has two branches called a
sympathetic branch and the
parasympathetic branch the sympathetic
branch revs up our energy to deal with
the threat the parasympathetic branch
puts on the brakes to this energy
arousal when it's no longer needed the
parasympathetic branch helps us to
regain our emotional balance and
restores our body to a normal resting
state however the research on gid
suggests that there are low levels of
parasympathetic control which means that
those with GA D don't put on the brakes
as frequently or effectively as they
should the result is our bodies get
stuck in a state of higher arousal when
they no longer need to be in a state of
high arousal kind of like they're stuck
in third gear in situations in which
they only need to be in second gear
which explains the classical physical
symptoms of GA D such as muscle tension
sleep difficulty irritability and
difficulty relaxing the third component
of g ID is behavior we want to highlight
three kinds of behavior in relation to
GA d first there is the behavior that is
the direct result of anxiety such as
difficulty concentrating and
restlessness
we want to target this behavior because
it compromises one's ability to solve
problems avoidance is another important
behavioral component of GA D when we
feel threatened by something we tend to
avoid it that's not always a bad thing
but if we are overestimating the threat
then avoiding it just reinforces the
notion that the threat is serious by
avoiding we miss the opportunity to see
that perhaps the threat is not as bad as
we predicted or that we can cope with it
the threat even if it is somewhat
difficult
another meaningful behavior involves
what we call over cautiousness or
reassurance seeking behavior examples
might include calling frequently to make
sure your family members are safe or
being overprotective with your children
such behavior may provide reassurance
briefly but ends up contributing to your
chronic worry now that you have a more
detailed understanding of the components
of GA D let's turn to the treatment
approach the cognitive behavioral
treatment of GA D is a scientific
approach in which you develop skills to
think behave and react physically in new
ways to overcome your chronic worry and
anxiety with CBT you will learn how to
alter the negative predictions which
lead you to feel unsafe and out of
control learn how to alter them by
thinking more accurately about the real
possibilities of something bad happening
you will learn how to think less
catastrophic ly and to rehearse coping
with real-life difficulties and CBT you
will learn how to shift your body from
its tense state caused by a constant
over arousal of your nervous system to a
more relaxed state thereby interrupting
the vicious cycle
Woori leading to physical tension
leading to more worry and so on you will
learn how to change your reassurance
seeking behavior so you learned that the
dangers you predict either do not happen
or you realize you can cope with them
you will learn how to take on situations
you may have avoided because of your
negative predictions and you will learn
effective problem-solving strategies to
deal with the legitimate stressful
events in your life I will describe some
of these skill sets in a few minutes but
first let me outline the first stage of
treatment which we call the
self-awareness or self monitoring stage
this is where we ask the client to
monitor and record their anxiety and
worry states so they can learn the when
where and under what circumstances they
have anxiety we also ask them to
pinpoint and record the particular
thoughts that make up their worried
state and the particular physical
symptoms they are experiencing when
anxious and the behaviors triggered by
their anxiety including behaviors they
display to try to get reassurance this
self-monitoring step has a number of
benefits most critically it identifies
the particular thinking feeling and
behavioral components of anxiety that we
want to target for treatment it also
facilitates becoming more of an observer
of one's anxiety and worry rather than
just being a victim of it by pinpointing
the conditions under which one gets
anxious and the different components of
the anxiety this manner this monitoring
counteracts one of the core
vulnerabilities of someone who has gid
namely that they feel that their anxiety
and worry is unpredictable and
uncontrollable becoming more of an
objective
observer of their anxiety rather than
just being swept up in it gives hope
that this condition can perhaps be
controlled and by keeping a record of
the frequency and intensity of the
anxiety episodes we have a record from
which to measure progress once we start
the treatment strategies after a few
sessions developing this self monitoring
skill the component of gid that we often
turn our attention to first is the
physical symptoms the physical tension
that is one of the hallmarks of chronic
worry this is an important target for
change because the physical symptoms are
painful often the reason someone seeks
out treatment and because this state of
chronic over arousal of the nervous
system leads to a greater susceptibility
to worry it would certainly be desirable
to have a tool to reduce this physical
tension well there is such a tool called
progressive muscle relaxation where the
person develops the skill to shift their
body from a tense state to a noticeably
more relaxed state a tool to bolster the
parasympathetic branch of their nervous
system progressive muscle relaxation is
much more than telling a person to relax
it is a key anxiety management skill
which requires a good deal of practice
another reason why we introduce it early
in treatment however once learned it can
be quite helpful here's how it works
first we ask you to focus on a
particular muscle group in your body my
muscle group we simply mean the muscles
in a particular part of your part of
your body such as the muscles in your
shoulder area muscles in your upper arms
or lower arms muscles surrounding your
abdomen
so on we start with one muscle group
let's say the muscles in your shoulder
area and ask you to tense up and those
muscles to scrunch up your shoulders and
make them tense and tight and then to
hold that tension for about 10 seconds
in this step you try to create as much
tension as you can and to focus on that
tension then we give a signal usually
saying the word relaxed whereby we asked
you to let go of the tension just let
the muscles go limp and relaxed we ask
you to keep your focus on that same
muscle group and notice the contrast
between the tension when your muscles
were scrunched up and the release of
tension the relaxation we ask you to
keep that focus on the relaxation for
about 20 seconds during which time we
ask you to say a word to yourselves
typically the word relaxed every time
you exhale now what's behind this
technique how is it effective by
creating tension and then releasing it
we've learned that this facilitates the
relaxation response it gives the
relaxation response some momentum kind
of like a pendulum that's set up high
and therefore swings higher to the other
side the relaxation response is stronger
after the release of tension by focusing
attention on the muscle groups you learn
that tension doesn't have to be your
default state but something you can
begin to exert some control over also by
focusing on the body and the
here-and-now you are weakening the
association between tension and worry if
you do notice where he's popping up
during the exercise we can encourage you
to do a mindfulness exercise such as
picturing the worries as clouds passing
by in the sky or is background noise
outside your apartment that you don't
have to pay it
- when we first teach progressive muscle
relaxation in the office we move from
one muscle group to the next initially
we go through 16 different muscle groups
in the body we then ask the client to
practice this progressive muscle
relaxants relaxation exercise at home
without distractions this is time
consuming initially it can take about 30
minutes to go through all the muscle
groups however we emphasize that it is a
skill and like any skill requires time
and practice this is the training phase
of progressive muscle relaxation we then
move to the application phase which
initially involves reducing the number
of muscle groups from 16-day we don't
eliminate any muscle groups we just
combine them so the client tenses and
relaxes more muscle groups together
covering a larger portion of the body by
reducing the number of muscle groups to
eight we shorten the procedure the
client then practices this until he
develops some mastery with it then we
shift the number of muscle groups to
four then two and finally a one-step
entire muscle relaxation shift we ask
the client to practice this one step
procedure with distractions thus they
are then able to carry this skill of
shifting from tension to relaxation into
real-life situations
progressive muscle relaxation is not a
magical cure-all for all the components
of GA d
but it is a concrete tool that provides
relief breaks up the vicious cycle of
tension leading to worry and gives the
client hope that they can have control
over what had been seen as an
uncontrollable condition now let's turn
our attention to the thinking component
the intense worry we described earlier I
here we're not talking about
constructive Ori which can help us
prepare for a problem but worry that is
excessive worry we can't turn off
fortunately there are many techniques we
can bring to bear to disrupt this
tendency to worry a colleague Robert Lee
he in an excellent self-help book called
the worry cure has outlined many of
these strategies most of them are
cognitive techniques aimed to identify
question and dispute the thoughts that
make up the worry
remember research has identified that
two of the frequent characteristics of
worry with GA D sufferers are the
tendency to overestimate the likelihood
of a negative event and the tendency to
imagine the worst-case scenario of a
negative event so how does this
disputing work particularly to challenge
these two key distortions in GA D the
first step is to identify the specifics
that make up the worry people with GA D
typically feel lost in a sea of worry
unable to view their anxiety and worry
objectively however in that
self-monitoring phase of treatment
clients realize that their worries are
really a list of specific thoughts
almost always predictions about
something bad that might happen in the
future by identifying the worries as
specific predictions the client begins
to feel not so overwhelmed by their
worries and feel that they are in a
better position to question those
predictions the next step is to do just
that to evaluate the real odds of
something undesirable happening we pose
questions such as what do you think the
real odds are of the negative prediction
coming true how often have you worried
about a particular negative outcome
for example getting fired or that a
loved one will get in an automobile
accident how many times have you worried
about those things and how many times
have they actually come true are there
facts or data you could seek out they
might help you make a more accurate
prediction such as the statistics of the
likelihood of someone getting into a
serious automobile accident
thus the client learns how to pose
questions that help determine the real
odds the real likelihood of some
negative event happening questions that
lead to answers that have integrity
meaning they are based on evidence the
next step that flows from this
questioning is to put into words or
pictures the more realistic scenario to
picture your spouse arriving home safely
in the car or perhaps picture a
conversation with your supervisor where
the supervisor might not be totally
happy with your work but the
conversation doesn't result in you
getting fired now how do we deal with
the second distortion and unproductive
worry
the tendency to imagine the worst case
scenario for example imagining that
you're going to be fired effort after
turning in a less-than-perfect report
imagine that you're going into
bankruptcy after incurring a little bit
of debt well first we always want to
question the likelihood of these
particular negative predictions but then
we go ahead and encourage the person to
picture their worst case scenario and
ask them to rate the severity of it in
the midst of worry they have almost
always considered the event as awful
god-awful catastrophic something they
just couldn't bear but if asked to
actually rate it we usually suggest a
scale of zero to a hundred or a hundred
represents the most awful thing they
imagine they often recognize that the
event they are worried about is not the
most awful event the event is
undesirable perhaps very undesirable but
there's a recognition that it is perhaps
not absolutely god-awful the next
question is to ask them to picture the
undesirable event and then imagine how
they might cope with it how life might
go on even if the undesirable event
happens
most people with GID don't take this
step and therefore in their minds
they're always stuck in this kind of
cliffhanger image the bad thing
happening or about to happen but not
what could happen next by picturing how
they might cope they realize they are
not stuck in a cliffhanger image and
that there might be things they could do
to deal with the unfortunate event D
catastrophizing is going from the
thought oh my god what if such-and-such
happens to the thought even if something
unfortunate happens
I can imagine coping with it and that
it's not absolutely insufferable now
let's turn to the behavioral component
of GID one of the key behavioral
components of GA D that we want to
target for change is what we call
reassurance or safety seeking behavior
this is behavior design to try to reduce
the possibility of some negative outcome
or to try to reduce the worry about that
outcome examples might be constantly
checking in with your family to make
sure they are safe or always staying
late at work to minimize the chance you
won't get your work done on time
this behavior may provide someone with
reassurance briefly but when relied upon
ends up reinforcing the worry because
the person doesn't give himself a chance
to see that the negative thing they are
worried about doesn't happen or if it
does can be made
instead of challenging their thinking
involved in their worry they engage in
behavior that gives in to the excessive
worry
thus we try to reduce this reassurance
seeking anxiety driven behavior and
replace it with non anxious behavior
such as calling your family less
frequently about their safety
not feeling compelled to stay at work
late every night to always get your work
done on time
the goal here is to build up the
behavior that goes along with tolerating
imperfection letting go of attempts to
control everything letting go of this
sense of responsibility for unlikely
events and recognizing that making
mistakes is part of being human when
someone pushes back against their
reassurance seeking behavior that can
cause an increase in anxiety in the
short run
therefore we usually focus on behavior
change after the person has learned the
coping skills of relaxation and thinking
more realistically they can then bring
these skills to bear on building up new
behavior new behavior that undermines
their general tendency to worry and be
tense and constantly seek reassurance
likewise if someone with GID has been
avoiding legitimate problems such as
seeing a doctor when appropriate or
developing a realistic budget we
encourage taking on these situations
especially since they now have new
coping skills pushing back on the
tendencies to seek reassurance and a
tendency to avoid situations that need
to be tackled will help cement the
tendency to worry less and help solve
problems more effectively this is the
ultimate goal of treatment I hope this
has given you a thumbnail sketch of how
CBT can help those
generalized anxiety disorder by
addressing the components of worried
physical tension and self-defeating
self-defeating behavior with specific
techniques I describe some of the
techniques but there are many other
techniques that can be helpful if you
want to learn about these techniques or
about the treatment of other anxiety
difficulties please don't hesitate to
visit our website I want to conclude by
emphasizing the GA D is a condition
worthy of treatment and fortunately
there is a research tested effective
treatment program to help those who
suffer from chronic worry thank you
you
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