Flexible Principles for the Treatment of Adult Worry

This chapter outlines various empirically supported cognitive-behavioral strategies driven by current understanding of worry-related mechanisms that may be implemented in the treatment of chronic worry. Excessive and uncontrollable worry is reliably observed across anxiety disorders, and it is most evident in generalized anxiety disorder (GAD), of which it is the cardinal symptom. At present, achieving treatment fidelity for cognitive behavioral therapy (CBT) for excessive worry requires cognitive restructuring—wherein targets can range from challenging overestimation of likelihood, severity of negative outcomes, or metacognitive beliefs about worry—and exposure, either in vivo or imaginal, as a means to provide extinction learning around feared outcomes involving uncertainty or aversive emotional experiences. It also requires behavioral experimentation through which worry-related cognitions are tested and challenged through “real-life” experiences, which may involve stimulus control/worry postponement; explicit removal of safety behaviors throughout all components of treatment; and incorporation of strategies to enhance problem orientation. Using a case formulation-driven approach, these elements can be flexibly applied in a systematic, responsive, and data-driven manner to target the deficits present in the individual.