Cognitive-Behavioral Therapy for Generalized Anxiety Disorder: Case Formulation and Evidence-Based Treatment Strategies

Generalized anxiety disorder (GAD) is a prevalent chronic disorder that is associated with significant psychosocial impairment. The hallmark feature of GAD is excessive and uncontrollable worry that occurs across multiple domains of life. Cognitive-behavioral therapy (CBT) is the most widely studied psychotherapy for GAD and has received strong empirical support in randomized controlled trials. Most CBT models conceptualize worry as an ineffective emotion regulation strategy that individuals use to cope with fear and anxiety. CBT for GAD therefore involves teaching patients to notice their habitual responses to fear and anxiety and utilize more helpful emotion regulation strategies when feeling these emotions. Common treatment strategies include psychoeducation, self-monitoring of worry episodes, applied relaxation, mindfulness exercises, cognitive reappraisal, behavioral experiments, imaginal exposure, and valued actions. In this chapter, we describe the goals and evidence base for these treatment strategies and demonstrate their use with a case vignette.