Intervention in GAD

Awareness and Psychoeducation of Preoccupation

The first step in treatment is awareness. Many patients come to consultation saying "I feel worried", confusing a mental process with an emotion.

The therapist should educate the patient to understand that worry is a cognitive process (verbal thoughts and images) and that anxiety is the emotional and physical reaction to that process.

The patient is asked to record his or her worries to identify patterns. It is crucial to differentiate between current problems (requiring solution) and hypothetical situations (requiring acceptance).

By labeling the thought as "this is a worry, not an impending reality," the patient begins to gain critical distance from his or her own mind.

The "Worry Time" Technique.

One of the most effective behavioral tools for GAD is the assignment of a "Worry Time."

Since asking the patient to "stop worrying" is ineffective (white bear effect), the patient is asked to postpone worrying.

A specific time of the day (e.g. 18.00 to 18.30) is chosen for voluntary worrying.

If a worry arises at 10.00 am, the patient writes it down and says to himself: "I will think about this at 18.00".

This has two effects: first, it frees up the rest of the day to be functional and concentrate on tasks; second, when the scheduled time arrives, the worry has often lost its emotional urgency or intensity, demonstrating to the patient that it was not as catastrophic as it initially appeared.

Exposure to Uncertainty

To attack the root of the problem, uncertainty exposure exercises are designed.

The goal is for the patient to learn that uncertainty is uncomfortable but tolerable, and that the catastrophes he or she fears rarely occur.

Tasks are prescribed such as: sending an email without triple checking it, not calling a family member to check that he or she arrived safely, being late for a non-crucial appointment, or delegating a task without supervising it.

By eliminating safety and checking behaviors, the patient experiences anxiety in the short term, but in the long term their brain learns that the world does not end because they are not in complete control of every variable.

Summary

Treatment begins by educating the patient to differentiate worry (thought) from anxiety (emotion). They learn to distinguish current problems, which require solution, from hypothetical situations that require acceptance of uncertainty.

The "Worry Time" technique consists of postponing ruminations to a fixed schedule. This frees up the day to be functional and reduces the emotional urgency of thoughts when confronted later in the day.

Exposure to uncertainty seeks to eliminate checking and safety behaviors. By willingly tolerating doubt, the brain learns that lack of absolute control does not lead to the feared catastrophes.