Cognitive Behavioral Therapy (CBT) of Anxiety


Published on

An overview of Cognitive Behavior Therapy (CBT) for anxiety and, in particular, generalized anxiety disorder (GAD). The clinical case material portion of presentation has been removed.

Published in: Design
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Cognitive Behavioral Therapy (CBT) of Anxiety

  1. 1. Cognitive (Behavioral) Therapy of Anxiety Disorders David J. Walczyk, Ed.D. C.G. Jung Institute of NY
  2. 2. As they relate to the cognitive therapy of anxiety disorders... Cognitive Model General Hypotheses Etiology Cognitive Intervention Case Formulation : GAD
  3. 3. Cognitive Model General Hypotheses EtiologyCognitive InterventionCase Formulation : GAD
  4. 4. “Modification of the exaggerated appraisals of threat, vulnerability, and safety seeking is the primaryobjective of cognitive therapy for anxiety disorders.”
  5. 5. “The goal of any cognitive intervention is deactivation of the hypervalent threat schemas and heightenedactivation of more adaptive and realistic beliefs aboutthreat and perceived ability to cope with one’s anxious concerns.”
  6. 6. Cognitive Model General Hypotheses EtiologyCognitive InterventionCase Formulation : GAD
  7. 7. 1. Attentional threat bias Selective attentional bias for negative stimuli2. Diminished attentional processing of safety Automatic attentional shift away from safety cues 3. Exaggerated threat appraisals Automatic evaluative process that exaggerates the threat 4. Threat-biased cognitive errors Commit more cognitive errors while processing threatening stimuli
  8. 8. 5. Negative interpretation of anxiety Generate more negative and threatening interpretations of subjective feelings and symptoms6. Elevated disorder-specific threat cognition Elevated frequency, intensity, and duration of negative automatic thoughts and images 7. Ineffective defensive strategies Less effective immediate defense strategies and evaluate defensive strategies as less effective 8. Facilitated threat elaboration Selective bias threat even towards ambiguous stimuli
  9. 9. 9. Inhibited safety elaboration Inhibitory bias of safety information relevant to selective themes - fewer themes of safety10. Detrimental cognitive compensatory strategiesE.g... worry has a greater adverse effect to enhancing threat salience 11. Elevated personal vulnerability Lower-self confidence and greater perceived helplessness in situations relevant to their selective threats 12. Enduring threat-related beliefs Preexisting maladaptive schemas about particular threats or dangers and associated personal vulnerability
  10. 10. Cognitive Model General Hypotheses EtiologyCognitive InterventionCase Formulation : GAD
  11. 11. “...vulnerability to anxiety disorders involves the interaction of multiple pathways emerging from constitutional, developmental, environmental,personality, and information-processing domains.”
  12. 12. “Based on this framework for vulnerability, we...consider the empirical evidence for the two maincomponents of the model: an enduring sense of personal vulnerability and the presence of hypervalent threat schemas.”
  13. 13. Cognitive Model General Hypotheses EtiologyCognitive InterventionCase Formulation : GAD
  14. 14. “Cognitive interventions seek to shift the clients perspective from one of exaggerated danger andpersonal vulnerability to a perspective of minimal acceptable threat and perceived ability to cope.”
  15. 15. What... Shift threat focus Tend to enter therapy believing that the cause of their anxiousness is the situation that triggers their anxious episode Focus on appraisals and beliefs An information-processing system that exaggerates the probability and severity of threat, minimizes personal ability to cope, and fails to recognize aspects of safety.Modify biased threat, vulnerability, and safety appraisals and beliefs Four key elements of faulty cognition : probability estimates, severity estimates, vulnerability estimates, and safety estimates Normalize fear and anxiety Normalize in relation to others, normalize in relation to past experiences, and normalize in relation to situations. Strengthen personal efficacy Correcting erroneous beliefs about personal vulnerability and perceived inability to deal with anxious concerns. Adaptive approach to safety Faculty risk appraisal, enhance safety-seeking processing, dysfunctional avoidance and safety-seeking behavior
  16. 16. How... Educating the client Define anxiety and fear, explain consequences, treatment goal, treatment strategySelf-monitoring and the identification of anxious thoughts Identify and record anxious behavior Cognitive restructuring Evidence gathering, cost-benefit analysis, decatastrophizing, identifying cognitive errors, generating alternatives, empirical hypothesis testing Identifying thinking errors To reinforce the message to clients that threat perception are inaccurate Generate and alternative explanation From rigidity to reflection Empirical hypothesis-testing Development and test hypothesis
  17. 17. Emerging Hows...Imaginal reprocessing and expressive writing* Mindfulness, acceptance, and commitment*
  18. 18. Cognitive Model General Hypotheses EtiologyCognitive InterventionCase Formulation : GAD
  19. 19. Primary goal of cognitive therapy of GAD...“...reduction in frequency, intensity, and duration of worry episodes that would lead to an associated decrease in automatic anxious intrusive thoughts and generalized anxiety. This will be achieved by modifying the dysfunctional appraisals and beliefs as well as the maladapative control strategies that are responsible for chronic worry.”
  20. 20. Case Formulation in conjunction with client... 1. Description of the primary worry concerns 2. Specification of current life goals and personal strivings 3. List of internal and external triggers of worry 4. Identification of metacognitive appraisals of worry of each worry concern 5 Description of idiosyncratic worry control profile 6. Extent of safety and search and negative problem orientation7. Formulation of the underlying schematic organization responsible for chronic worry and generalized anxiety.
  21. 21. Case Formulation in conjunction with client... 1. Focus on identifying the dysfunctional schemas and faulty metacognitive processes of worry. 2. Assess the client’s primary worried and associated anxious symptoms (use ADIS-IV to assess context of worry, presence of safety-seeking responses, and degree of interference in daily life). 3. Identify client’s personal goals and current concerns. 4. Identify worry triggers (using the Worry Self-Monitoring Form B) 5. Identify client’s metacognitive appraisals of worry 6. Identify Worry Control Strategies using the Cognitive Response to Anxiety Checklist 7. Develop safety scripts and problem orientation8. Identify core maladaptive schemas of threat, personal vulnerability, intolerance of uncertainty, and metacognitive beliefs about worry
  22. 22. Primary source...Cognitive Therapy of Anxiety Disorders Science and Practice David A. Clark and Aaron T. Beck (2011)
  23. 23. Thanks!