Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice

264 Pages·2006·3.25 MB·English

by  Michel J. Dugas

Cognitive-Behavioral
Treatment for
Generalized Anxiety
Disorder
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Practical Clinical
Guidebooks Series
Rosqvist Exposure Treatments for Anxiety
Disorders: A Practitioner’s Guide to
Concepts, Methods, and Evidence-
based Practice
Marshall, Marshall, Serran Treating Sexual Offenders: An
and Fernandez Integrated Approach
Emmelkamp and Vedel Evidence-Based Treatments for
Alcohol and Drug Abuse:
A Practitioner’s Guide to Theory,
Methods, and Practice
Dugas and Robichaud Cognitive-Behavioral Treatment for
Generalized Anxiety Disorder: From
Science to Practice
ii
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Cognitive-Behavioral
Treatment for
Generalized Anxiety
Disorder
From Science to Practice
Michel J. Dugas
Melisa Robichaud
New York London
Routledge is an imprint of the
Taylor & Francis Group, an informa business
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Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
270 Madison Avenue 2 Park Square
New York, NY 10016 Milton Park, Abingdon
Oxon OX14 4RN
© 2007 by Taylor & Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group, an Informa business
Printed in the United States of America on acid‑free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number‑10: 0‑415‑95211‑5 (Softcover) 0‑415‑95210‑7 (Hardcover)
International Standard Book Number‑13: 978‑0‑415‑95211‑8 (Softcover) 978‑0‑415‑95210‑1 (Hardcover)
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic,
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Library of Congress Cataloging‑in‑Publication Data
Dugas, Michel J. (Michel Jospeh), 1961‑
Cognitive‑behavioral treatment for generalized anxiety disorder : from science to
practice / Michel J. Dugas, Melisa Robichaud.
p. ; cm. ‑‑ (Practical clinical guidebooks series)
Includes bibliographical references.
ISBN 0‑415‑95210‑7 (hb : alk. paper) ‑‑ ISBN 0‑415‑95211‑5 (pb : alk. paper)
1. Cognitive therapy. 2. Anxiety disorders‑‑Treatment. I. Robichaud, Melisa. II.
Title. III. Series.
[DNLM: 1. Anxiety Disorders‑‑therapy. 2. Cognitive Therapy‑‑methods. WM
172 D866c 2007]
RC489.C63D84 2007
616.89’142‑‑dc22 2006014598
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the Routledge Web site at
http://www.routledgementalhealth.com
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À Céline, Jérémie et Sophie — M.J.D.
To Carolyn and Antony — M.R.
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Contents
Preface xi
Acknowledgments xiii
Chapter 1: Description of Generalized Anxiety Disorder 1
Diagnosis of GAD 3
Clinical Picture: What Does GAD Look Like? 7
Epidemiology 12
The Cost of GAD 18
Summary and Concluding Remarks 20
Chapter 2: A Cognitive Model of Generalized Anxiety
Disorder 23
Intolerance of Uncertainty 24
Positive Beliefs about Worry 35
Negative Problem Orientation 37
Cognitive Avoidance 41
Connections between Model Components 44
Clinical Implications of the Model 45
Chapter 3: Diagnosis and Assessment 47
The Clinical Interview 47
Obstacles to the Diagnosis of GAD 52
Differential Diagnosis 55
Structured Diagnostic Interviews 61
Self-Report Questionnaires 67
Summary and Concluding Remarks 73
Appendix 3.1 Worry and Anxiety Questionnaire (WAQ) 75
Appendix 3.2 Penn State Worry Questionnaire (PSWQ) 77
Appendix 3.3 Intolerance of Uncertainty Scale (IUS) 78
vii
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Contents
Appendix 3.4 Why Worry II (WW-II) 80
Appendix 3.5 Negative Problem Orientation
Questionnaire (NPOQ) 82
Appendix 3.6 Cognitive Avoidance Questionnaire (CAQ) 83
Chapter 4: Treatment Overview 85
Treatment Outline 85
Module 1: Psychoeducation and Worry Awareness
Training 87
Module 2: Uncertainty Recognition and Behavioral
Exposure 93
Module 3: Reevaluation of the Usefulness of Worry 96
Module 4: Problem-Solving Training 98
Module 5: Imaginal Exposure 101
Module 6: Relapse Prevention 104
Summary and Concluding Remarks 105
Chapter 5: Step-by-Step Treatment 107
Module 1: Psychoeducation and Worry Awareness
Training 107
Module 2: Uncertainty Recognition and Behavioral
Exposure 117
Module 3: Reevaluation of the Usefulness of Worry 124
Module 4: Problem-Solving Training 133
Module 5: Imaginal Exposure 150
Module 6: Relapse Prevention 161
Appendix 5.1 Model 1: The Symptoms Associated with
GAD 166
Appendix 5.2 Handout for Model 1: Worry Diary Form 167
Appendix 5.3 Model 2: The Role of Intolerance of
Uncertainty 168
Appendix 5.4 Handout for Model 2: Uncertainty and
Behavior Monitoring Form 169
Appendix 5.5 Model 3: The Role of Positive Beliefs
about Worry 170
Appendix 5.6 Handout for Model 3: Handout for Positive
Beliefs about Worry 171
Appendix 5.7 Model 4: The Role of Negative Problem
Orientation 173
Appendix 5.8 Handout for Model 4: Resolution of a
Problem Form 174
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Contents ix
Appendix 5.9 Model 5: The Role of Cognitive
Avoidance 175
Appendix 5.10 Handout 1 for Model 5: Scenario for
Exposure Form 176
Appendix 5.11 Handout 2 for Model 5: Exposure
Summary Form 177
Appendix 5.12 Model 6: The Influence of Mood State
and Life Events 178
Chapter 6: Treatment Efficacy
179
Criteria for Establishing Treatment Efficacy 179
Studies of Treatment Efficacy 183
General Conclusions 195
Chapter 7: Addressing Complicating Factors 199
Client Complicating Factors 199
Therapist Complicating Factors 209
Contextual Complicating Factors 213
Concluding Remarks 216
References 221
Index 235
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