Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)

Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Other common symptoms include restlessness, physical arousal, difficulty concentrating, muscle tension, and poor sleep. Numerous models of GAD have been developed. Early models conceptualized GAD in the relatively generic cognitive terms of an individual’s heightened preoccupation with danger and underestimation of their ability to cope (e.g Butler et al, 1987; Borkovec et al, 1993). Second-generation conceptualizations including the Laval model (presented here) and Wells’ metacognitive model (e.g. Wells, 1999) are significant advancements. 

The Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD) presented here describes four factors which are thought to be important in the maintenance of GAD. These include:

• Intolerance of uncertainty (IoU) which is an aversive reaction to situations or events which are uncertain, or where the outcome is uncertain. People with GAD tend to be be high in IoU.
• Positive beliefs about worry which may include beliefs such as “worrying helps me to find solutions to problems” and “worrying can prevent bad things from happening”.
• Negative problem orientation which can be understood as an individual’s appraisals of their effectiveness at solving problems which they encounter.
• Cognitive avoidance which describes strategies that people with GAD engage in to avoid anxious thoughts or feelings. These might include suppressing worries, or avoiding situations that lead to worrying.

• Client handout – use as a psychoeducation resource
• Discussion point – use to provoke a discussion and explore client beliefs
• Therapist learning tool – improve your familiarity with a psychological construct
• Teaching resource – use as a learning tool during training

• Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61(4), 611. 
• Butler, G., Cullington, A., Hibbert, G., Klimes, I., & Gelder, M. G. (1987). Anxiety management for persistent generalised anxiety. The British Journal of Psychiatry, 151(4), 535-542. 
• Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215-226.
• Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.