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9 - Cognitive Behavioral Therapy for Generalized Anxiety Disorder:

Targeting Intolerance of Uncertainty

from Part One - Cognitive Behavioral Therapy for Anxiety Disorders

Published online by Cambridge University Press:  06 January 2022

By
Cara R. Dunkley  and
Melisa Robichaud
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
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Summary

This chapter outlines the application of a cognitive behavioral protocol targeting intolerance of uncertainty (CBT-IU) for the treatment of GAD. The theoretical rationale and empirical support for the CBT-IU protocol are presented, followed by an overview of assessment and case conceptualization and a description of each treatment module. Intolerance of uncertainty is viewed as a higher-order cognitive process that drives the development and maintenance of the worry cycle in GAD. Negative beliefs about uncertainty and its consequences are posited to lower the tolerance threshold for the uncertainty in daily life situations, and lead to worry as an attempt to reduce uncertainty through mental planning and preparing. CBT-IU treatment components include (1) psychoeducation and worry awareness training, (2) reevaluation of the usefulness of worry, (3) reevaluation of negative beliefs about uncertainty, identification of safety behaviors, and belief testing through behavioral experiments, (4) problem-solving training and reorientation, (5) written exposure for hypothetical worries, and (6) relapse prevention planning. Each module can be flexibly applied according to a client’s particular presentation. The overarching goal of CBT-IU is to increase tolerance to uncertainty by developing more balanced beliefs about uncertainty and its consequences.

Keywords

generalized anxiety disorderintolerance of uncertaintycognitive behavioral therapyexcessive worryanxietybehavioral experiments
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 152 - 174
Publisher: Cambridge University Press
Print publication year: 2022

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References

Further Recommended Reading

Hebert, E. A., & Dugas, M. J. (2018). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, https://doi.org/10.1016/j.cbpra.2018.07.007Google Scholar
Koerner, N., Mejia, T., & Kusec, A. (2017). What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder. Cognitive Behavior Therapy, 46, 141–161.Google Scholar
Robichaud, M., & Dugas, M. J. (2015). The generalized anxiety disorder workbook: A comprehensive CBT guide for coping with uncertainty, worry, and fear. New Harbinger.Google Scholar
Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.Google Scholar

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