Tom Borkovec and his colleagues have done excellent work with worry and Generalized Anxiety Disorder.  Our Cognitive Behavior Therapy approach to this disorder is based on theirs and includes two strategic components:

• Cognitive Therapy

  • This is therapy for the conscious, thinking left brain.  
  • The focus is on learning new, less anxiety-provoking ways of perceiving oneself, the world, and the future.
  • Anxiety is described as a habitual spiral process wherein the perception of threat leads to anxiety reactions including thoughts [especially worry], images, body reactions, and affect.
  • The client's task is to learn to detect the incipient spiral and to substitute alternative, more accurate perspectives.
  • Techniques include: logical analysis, examination of evidence and probabilities, identifying logical errors, de-catastrophizing, and generating alternative thoughts and beliefs.
  • The client is encouraged to apply alternative perspectives early upon identification of incipient anxiety during daily living.
     

• Experiential Therapy

  • This is therapy for the experiential, feeling right brain.  
  • Therapy involves self-monitoring of internal reactions and their sequential nature: Learning to catch the spiral early and intervene with a variety of relaxation responses to anxious thoughts, feelings and images.  To disrupt anxiety spirals, and to create new coping habits; learning to focus attention on present-moment experience rather than on mentally created past events or future possibilities; and imaginary rehearsal of coping methods to facilitate fear extinction and healthy habit acquisition.
  • Hypnotherapy and self-hypnosis training to develop the ability to relax on cue.
  • The client practices deploying their relaxation responses frequently throughout the day, and in response to incipient anxiety cues.
  • Develop alternative self-statements - e.g., "Can you think of an equally true or more likely alternative self-statement that is less anxiety arousing?"
  • Flexible choice of relaxation methods depending on the internal and external circumstances and on discovery oriented experimentation.
  • Desensitization procedure
    • Anxiety cue hierarchies are constructed from client's information
    • While client is deeply relaxed, external and internal anxiety cues - including incipient worry about topics of current concern - are presented until client signals the presence of anxious feelings.
    • Client continues to visualize the anxiety provoking situation while imagining deploying the coping response - e.g., cued relaxation.
    • At the elimination of anxiety the client imagines continued deployment of the coping tactic for an additional 20 seconds.
    • Scenes are repeated until client could no longer generate any anxiety, or was able to rapidly eliminate it [within 5-7 sec].
    • The the procedure is repeated for the next scene in the hierarchy.
       

Footnotes:

1. T. D. Borkovec, Michelle G. Newman, and Aaron L. Pincus & Richard Lytle A Component Analysis of Cognitive–Behavioral Therapy for Generalized Anxiety Disorder and the Role of Interpersonal Problems Journal of Consulting and Clinical Psychology 2002, 70, 288–298

Student:  Master, what is Zen?

 Master:  Zen is eating when you eat, working when you work, and relaxing when you relax.

 Student:  But Master, that is so simple!

Master:  Yes, but so few people do it.