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Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)
A licensed copy of the Hebert & Dugas (2019) cognitive behavioral model of intolerance of uncertainty and generalized anxiety disorder symptoms which describes a framework to address the core components and symptoms of GAD.
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Overview
Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry, often accompanied by symptoms such as restlessness, fatigue, and sleep difficulties. A key psychological factor in GAD is intolerance of uncertainty (IU) — a tendency to react negatively to situations that are ambiguous or unpredictable.
The original Dugas et al. (1998) model positioned IU as a central vulnerability in GAD, shaping how individuals perceive and respond to uncertainty. In their 2019 update, Hebert and Dugas refined this framework, placing greater emphasis on how people appraise uncertainty itself — not just their worries. This updated model provides clinicians with a more precise lens through which to understand and treat GAD. The model supports targeted interventions aimed at helping clients confront and reframe their beliefs about uncertainty, reducing worry and anxiety in meaningful, lasting ways.
Why Use This Resource?
Professionals seeking effective approaches for GAD treatment will find this resource invaluable. By focusing on intolerance of uncertainty, clinicians can:
- A comprehensive framework for understanding generalized anxiety disorder and persistent worry.
- Facilitates psychoeducation and enhanced client understanding of their condition.
- Can inform assessment and case conceptualisation.
- Guides the use of appropriate interventions.
Key Benefits
Insight
Clarifies the role of uncertainty in GAD symptom maintenance.
Practicality
Guides strategies for creating uncertainty-focused interventions.
Precision
Can help to tailor treatment plans for tackling individual beliefs about uncertainty.
Who is this for?
Generalized anxiety disorder (GAD)
Persistent, excessive worry impacting daily life.
Difficulty tolerating uncertainty
Fear of unknown outcomes resulting in avoidance and safety behaviors.
Integrating it into your practice
01
Learn
Understand more about the cognitive behavioral model of intolerance of uncertainty.
02
Template
Use the model as a template to organize your case formulations.
03
Educate
Use your knowledge of the model to explain maintenance processes to clients.
04
Discuss
Engage clients in discussions about their beliefs and behaviors.
05
Tailor
Customize interventions based on individual maintenance mechanisms.
06
Reflect
Use in supervision to discuss formulation and treatment plans.
Theoretical Background & Therapist Guidance
The Cognitive Behavioral Model Of Intolerance Of Uncertainty (IU) offers a structured explanation for how generalized anxiety disorder (GAD) develops and is maintained. Earlier cognitive models of anxiety focused broadly on perceived danger and overestimation of threat, but they struggled to account for the persistent, uncontrollable worry that defines GAD.
The concept of IU was introduced to address this gap. It describes a dispositional tendency to react negatively — emotionally, cognitively, and behaviorally — to uncertain situations. Individuals high in IU find ambiguity distressing and are more likely to interpret uncertain events as threatening. This makes IU a key vulnerability factor for chronic worry and anxiety.
The original 1998 model by Dugas and colleagues identified IU as central to GAD, alongside related cognitive and behavioral processes (e.g. positive beliefs about worry, poor problem orientation, cognitive avoidance). In the 2019 update, Hebert and Dugas shifted focus toward how people appraise uncertainty itself, rather than worry more generally. This refined model draws attention to the interpretations that individuals attach to uncertainty — e.g., “If I don’t know what will happen, something bad is likely to occur.”
This emphasis on appraisals aligns with cognitive behavioral formulations in related areas such as obsessive compulsive disorder (OCD) and panic disorder, where distorted interpretations of internal experiences play a central role. For therapists, the Hebert & Dugas (2019) model offers a clear, evidence-based framework to support case conceptualization, psychoeducation, and treatment planning. It highlights the importance of exploring clients’ beliefs about uncertainty and using these insights to guide collaborative formulation and therapeutic focus.
What's inside
- Graphical depiction of the model.
- Insights into key maintenance mechanisms.
- Guidelines for using the information with clients resource.
FAQs
The model emphasizes the role of intolerance of uncertainty in maintaining anxiety symptoms, informing targeted interventions to challenge and change these beliefs.
Behavioral experiments offer clients experiential insights, challenging unhelpful beliefs and reducing anxiety driven by uncertainty.
Behavioral experiments directly target and test beliefs about uncertainty, encouraging clients to engage with uncertainty rather than avoid it.
How This Resource Improves Clinical Outcomes
By applying the model, therapists and clients benefit from:
- Targeted interventions focusing on common maintenance mechanisms.
- Enhanced client engagement through increased understanding of their condition.
- Improved treatment outcomes by addressing core psychological features.
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References And Further Reading
- Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30-43.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470.
- 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.
- Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791-802.
- Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioural Practice, 26(2), 421-436.
- Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53-63.
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