Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)

Individuals with generalized anxiety disorder (GAD) report significant worry which they find difficult to control and experience as distressing. Other common symptoms include restlessness, physical arousal, difficulty concentrating, muscle tension, and poor sleep. Early psychological models of GAD conceptualized the anxiety in relatively generic cognitive terms of an individual’s heightened preoccupation with danger and underestimation of their ability to cope, or describing worry as a failed attempt at problem-solving (e.g. Butler et al, 1987; Borkovec et al, 1993; Roemer, Orsillo, Barlow, 2002). Treatments derived from these models had limits to their effectiveness, with GAD being described as “largely impervious to traditional cognitive restructuring approaches” (Hebert & Dugas, 2019). Confusingly, many people struggling with GAD reported high levels of threat even in the absence of objective risk, difficulties, or danger (Milne, Lomax & Freeston, 2019). 

Dugas, Gagnon, Ladouceur & Freeston’s cognitive-behavioral model of GAD, published in 1998, gave a central role

1. Psychoeducation. Introduce the concepts of uncertainty (situations where you don’t know the outcome) and intolerance of uncertainty (more than just a dislike of uncertainty: “almost as if you have a ‘psychological allergy’ in which a small amount of uncertainty produces a powerful reaction”). “Do these descriptions sound like they related to you at all?”, “Can you identify with having strong reactions to uncertainty?”
2. Explore the client’s typical triggers for - and reactions to - uncertainty. Common triggers for uncertainty are novel, ambiguous, or unpredictable situations. “Can you give me some examples of uncertain situations that bother you?" (The therapist can notice qualities of novelty, ambiguity, or unpredictability), “How do you typically feel in situations that are unpredictable?", "Can you

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