Worry

Question 1

What are the 3 models in GAD

Answer 1

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

Question 2

Wells - metacognitive model concept

Answer 2

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.

Question 3

Wells - metacognitive model tx

Answer 3

1. Case formulation
2. Psychoeducation
3. Challenge type2 worries of positive and neg beliefs

Question 4

Borkovek - avoidance model concept

Answer 4

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

Question 5

Borkovec - avoidance model tx

Answer 5

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

Question 6

Dugas - intolerance of uncertainty model Concept

Answer 6

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

Question 7

Dugas - intolerance of uncertainty Tx

Answer 7

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​

Question 8

Worry control strategies

Answer 8

Cognitive restructure about worry beliefs
Behavioral experiments to challenge beliefs​
Acceptance of uncertainty
Problem-solving

Question 9

how to challenge neg worry beliefs

Answer 9

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?

Question 10

how to BE for worry

Answer 10

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’

Question 11

Behaviour exp - worry make me go crazy

Answer 11

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

Question 12

Challenge positive benefits of woryr

Answer 12

Cons of worrying?

How many situations have turned out OK and you haven’t worried?

Question 13

Testing the Belief

Answer 13

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?​

​

Question 14

Behavioural Exp example

Answer 14

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?

Question 15

Acceptance

Answer 15

Do the opposite and awareness of worry thoughts, no suppression - be observer
Allow thoughts and feelings - stay in the present , refocus on environment

Question 16

Uncertainty

Answer 16

Advantages and disadvantages of seeking certainty
Predictions of unpleasant outcomes when uncertain – are good outcomes just as likely
Behavioural exp to test assumptions about need for certainty

Question 17

Decision tree process

Answer 17

Worry- is there any action to be taken (ie solvable vs unsolvable) ?​

Is it a real and likely problem that requires action?​

If so, what?​

When should it be taken? (ie now or when and if it happens?)​

If now, SPS….​