Table Of ContentMastery of Your Anxiety
and Worry:
Therapist Guide,
Second Edition
Richard E. Zinbarg
Michelle G. Craske
David H. Barlow
OXFORD UNIVERSITY PRESS
Master y of Your Anxiety and Worr y
--
David H. Barlow, Ph.D.
Anne Marie Albano, Ph.D.
Jack M. Gorman, M.D.
Peter E. Nathan, Ph.D.
Bonnie Spring, Ph.D.
Paul Salkovskis, Ph.D.
G. Terence Wilson, Ph.D.
John R. Weisz, Ph.D.
Mastery of Your
Anxiety and Worry
S E C O N D E D I T I O N
T h e r a p i s t G u i d e
Richard E. Zinbarg • Michelle G. Craske
David H. Barlow
1
1
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Library ofCongress Cataloging-in-Publishing Data
Zinbarg, Richard E.
Mastery ofyour anxiety and worry : therapist guide / Richard E. Zinbarg,
Michelle G. Craske, David H. Barlow.—nd ed.
p. cm.
Rev. ed. of: Mastery ofyour anxiety and worry / Michelle G. Craske.
Includes bibliographical references.
ISBN- ---- (pbk.)
ISBN--- (pbk.)
. Anxiety—Treatment. . Worry—Treatment. . Stress management.
. Self-help techniques. I. Craske, Michelle Genevieve
II. Barlow, David H. III. Title
[DNLM: . Anxiety Disorders—therapy. . Stress, Psychological—therapy.
. Psychotherapy—methods. WM Zm]
RC.C
.(cid:1)—dc
Printed in the United States ofAmerica
on acid-free paper
A b o u t Tr e a t m e n t s T h a t W o r k ™
Stunning developments in health care have taken place over the last sev-
eral years, but many of our widely accepted interventions and strategies
in mental health and behavioral medicine have been brought into ques-
tion by research evidence as not only lacking benefit, but also perhaps
inducing harm. Other strategies have been proven effective using the
best current standards of evidence, resulting in broad-based recommen-
dations to make these practices more available to the public. Several re-
cent developments are behind this revolution. First, we have arrived at a
much deeper understanding ofpathology, both psychological and physi-
cal, that has led to the development ofnew, more precisely targeted inter-
ventions. Second, our research methods have improved substantially, such
that we have reduced threats to internal and external validity, making the
outcomes more directly applicable to clinical situations. Third, govern-
ments around the world, as well as health care systems and policymakers,
have decided that the quality of care should improve, that it should be
evidence-based, and that it is in the public’s interest to ensure that these
changes occur (Barlow, ; Institute of Medicine, ).
Ofcourse, the major stumbling block for clinicians everywhere is the ac-
cessibility ofnewly developed evidence-based psychological interventions.
Workshops and books can go only so far in acquainting responsible and
conscientious practitioners with the latest practices in behavioral health
care and their applicability to individual patients. This new series, “Treat-
mentsThat Work™,” is devoted to communicating these exciting new
interventions to clinicians on the frontlines of practice.
The manuals and workbooks in this series contain step-by-step, detailed
procedures for assessing and treating specific problems and diagnoses.
But this series also goes beyond the books and manuals by providing an-
cillary materials that will approximate the supervisory process in assist-
ing practitioners in implementing these procedures in their practice.
In our emerging health care system, the growing consensus is that
evidence-based practice offers the most responsible course of action for
the mental health professional. All behavioral health care clinicians deeply
desire to provide the best possible care for their patients. In this series,
our aim is to close the gap between dissemination and information and
make that possible.
This therapist guide and the companion workbook for clients address
the treatment of generalized anxiety disorder (GAD). This disorder oc-
curs in approximately % of the population (about two-thirds of them
female), but is underrecognized and undertreated. With its characteristic
symptoms ofuncontrollable, unstoppable worry about upcoming events,
accompanied by chronic tension, fatigue, irritability, and difficulty sleep-
ing,GAD can cause significant impairment. Most people seek treatment
for this condition in primary care medical settings, where cognitive-
behavioral treatments are seldom available.
During the past years, we have developed increasingly effective treat-
ments for GAD, to the point where these interventions compare favor-
ably with the best psychological treatments for other disorders (Borko-
vec & Ruscio, ). These treatments also have the advantage ofproven
durability after treatment ends, with the added benefit ofallowing either
substantial reduction or elimination of any anxiolytic medications pre-
scribed before this treatment (Barlow, ). The approach in this man-
ual was developed in our Center in the early s, and has now been
substantially updated with the latest developments. We are gratified that
countless numbers of individuals with GAD, in the hands of skilled
therapists, have reported substantial benefit from this program.
David H. Barlow, Editor-in-Chief,
Treatments That Work™
Boston, MA
vi
C o n t e n t s
Chapter Introductory Information for Therapists
Chapter The Nature of Anxiety and Generalized Anxiety
Disorder
Chapter Outline of the Treatment Procedures and the Basic
Principles Underlying Treatment
Chapter The Nature of Generalized Anxiety
Chapter Learning to Recognize Your Own Anxiety
Chapter The Purpose and Function of Anxiety
Chapter A Closer Look at Generalized Anxiety Disorder
Chapter Learning to Relax
Chapter Controlling Thoughts That Cause Anxiety:
I. Overestimating the Risk
Chapter Controlling Thoughts That Cause Anxiety:
II. Thinking the Worst
Chapter Getting to the Heart ofWorrying:
Facing Your Fears
Chapter From Fears to Behaviors
Chapter Dealing with Real Problems:
Time Management, Goal Setting, and
Problem Solving
Chapter Drugs for Anxiety and Their Relation
to This Program
Chapter Your Accomplishments and Your Future
References
About the Authors
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Chapter 1 Introductory Information for Therapists
The Mastery of Your Anxiety and Worry (MAW) program is designed
to be presented in or more separate sessions that may be conducted
either individually or in small groups. Ifadministered individually, each
session should take approximately minutes. Typically, we allocate
minutes for each session when conducting the program in small groups
ofsix or eight. It is recommended that the therapist: () explain the prin-
ciples and practices relevant to each ofthe lessons described in the MAW
workbook, and () ask the clients to read the relevant material from the
MAW workbook and complete the specified practice exercises between
sessions. Beginning in chapter ofthis therapist guide, the major points
of each session, the primary information that should be covered by the
therapist, and the principles underlying the therapeutic procedures are de-
scribed. Typical questions asked by patients and problems that may arise,
based on our experience, are also included.
Who Will Benefit from This Program?
This program is designed for people who suffer primarily from worry and
tension. It is ideally suited for those who meet the criteria for the diagno-
sis of generalized anxiety disorder (GAD) in the Diagnostic and Statisti-
cal Manual ofMental Disorders,th edition, Text Revision (DSM-IV-TR),
but will also be useful for those individuals who have occasional worries or
tension, but do not meet the severity criteria for GAD. The DSM-IV-TR
criteria for the diagnosis ofGAD are given later. The key feature ofGAD
in the DSM-IV-TRis excessive and pervasive worry for at least months.
In thiscontext, excessive worry means that the intensity, duration, or fre-
quency of worry exceeds the actual likelihood or negative consequences
of the event that is the object of worry. In addition, the worry has the
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Description:This 13-session program incorporates new procedures to help clients learn to monitor their anxiety, gain control, and initiate needed change through cognitive restructuring, progressive muscle relaxation, and direct confrontation of unnecessary worry using imagery and In Vivo Experience. The videota
