Worry Flashcards
What are the 3 models in GAD
Wells - metacognitive model - worry about worry
Borkovek - avoidance model of imagery
Dugas - intolerance of uncertainty model
Worry is problem solving gone wrong. Concern turns into preoccupation - common with uncertainty and imagining the worst
Wells - metacognitive model concept
Type 1 worry creates anxiety , then type 2 worries about how bad or uncontrollable the worry is < leads to more worry > suppression or avoidance > disconfirmation of beliefs about worry.
Wells - metacognitive model tx
- Case formulation
- Psychoeducation
- Challenge type2 worries of positive and neg beliefs
Borkovek - avoidance model concept
Worry is a form of coping by somatic and emotional avoidance caused by images so worry in words which is a form of avoidance > increases worry and cycle continues because fear is not disconfirmed
Worry is negatively reinforced because it removes the aversive imagery and by the positive beliefs that problem solving and is further reinforced when negative event does not happen
Borkovec - avoidance model tx
EXPOSURE!!! to Imagery
Self- Monitoring Relaxation strategies (PMR breathing) Desensitization – to visual imagery Gradual stimulus control - worry time Cognitive restructuring Present moment focus Expectancy free living
Dugas - intolerance of uncertainty model Concept
Difficulty in accepting uncertainties that cannot be resolved. Focus is on the feared outcome rather than solving the problem. Worry may feel like problem-solving, but worry makes it harder to concentrate and make decisions so increases rather than decreases uncertainty.
Coping by avoidance and thought control
Dugas - intolerance of uncertainty Tx
Increasing tolerance to uncertainty by:
Self Monitoring
Education about IoU
Evaluating worry beliefs
Problem orientation – positive orientation (opportunities rather than threats)
Process core fears – exposure to threatening mental imagery
Worry control strategies
Cognitive restructure about worry beliefs
Behavioral experiments to challenge beliefs
Acceptance of uncertainty
Problem-solving
how to challenge neg worry beliefs
That worry is uncontrollable ask - has worry ever been interrupted or stopped by external events? Does the worry ever stop? engage in worry time to control how often and when
dangerous - how can be good but bad for health? what harm done so far, what about people in stressful jobs?
how to BE for worry
Lack of control eg I have no control over my worry and need to keep trying to suppress it
Prediction: My worry will be out of control if I don’t try and not think about it
Demonstration of the paradoxical effect of thought suppression
Establishing a worry time – notebook of things (single word) to worry about later in the day
Outcome: recognized difficulties (futility) in trying to control worry by trying to not think about them
Had some difficulties recalling specific worries in her ‘worry time’
Behaviour exp - worry make me go crazy
In session focus on the worry – (exposure + suds ratings) – allow yourself to go crazy
Anxiety increased followed by significant decreases
Not convincing but helpful in challenging the dangerousness of worry
Challenge positive benefits of woryr
Cons of worrying?
How many situations have turned out OK and you haven’t worried?
Testing the Belief
Situation that caused concern – what did the person think would happen (all the disastrous scenarios)
What actually happened (factual account)
What actually happened versus what the worry predicted would happen
What can the individual learn from this exercise
Same process for when she had worried and things went wrong anyway – how did the worry assist in dealing with the problem?
Behavioural Exp example
Challenging the utility of worry – alternate days with increased worry, days with postponed worry (or minimal worry)
Predictions of what will happen days when worries and days when doesn’t
monitoring of what happened
Compare predictions
What learnt?
Acceptance
Do the opposite and awareness of worry thoughts, no suppression - be observer
Allow thoughts and feelings - stay in the present , refocus on environment