Generalized Anxiety Disorder

Therapists and clinical scientists involved in the study, assessment, and treatment of generalized anxiety disorder (GAD) undoubtedly encounter individuals preoccupied with intense and pervasive worry and anxiety. Whereas worry is a universal experience, common in both nonpathological and anxious populations, individuals with GAD stand apart, as their worry is more pervasive and less controllable, thereby engendering greater distress and life interference. Typically describing themselves as lifelong worriers, these individuals perceive their worrisome thinking and associated anxiety as facets of their personality, enduring traits rather than phenomena prone to fluctuations that can be monitored, targeted, and effectively changed. In fact, worry may be viewed as such a central part of life, a primary coping strategy used to avoid perceived threat and changes in emotional reactivity, that treatment may not even be considered (Newman, Crits-Christoph, & Szkodny, in press). GAD has been referred to as the “basic” anxiety disorder (Brown, Barlow, & Liebowitz, 1994), an appellation that suggests understanding the development and maintenance of GAD is important for understanding all anxiety disorders. Given GAD’s course and documented resistance to change, research has centered not only on elucidating the nature and etiology of this disorder, but also on developing treatments that improve upon standard versions of cognitive behavioral therapy (CBT). This has been most critical since worry is a means to avoid anticipated threats, as opposed to tangible, anxiety-provoking stimuli, and thus is not as easily addressed with exposure interventions commonly executed in the treatment of other anxiety disorders (Newman & Borkovec, 2002). The principal objective of this chapter is to present an overview of CBT for GAD. First, the symptomatology of GAD is discussed, followed by a presentation of the cognitive behavioral treatment rationale and CBT techniques. Additionally, empirical evidence supporting the efficacy of CBT for GAD